Severe asthma · UK
Asthma biologics clinic, phenotype first.
Six licensed monoclonal antibodies for severe asthma in the UK. We match the right one to your eosinophils, FeNO, IgE and comorbidities, inside a tertiary MDT, with home injection once you are steady.
Why patients choose us
- 01
A specialist severe asthma consultant, in a tertiary centre
Not a general respiratory clinic. A named severe asthma physician working inside an MDT that phenotypes before it prescribes.
- 02
The right biologic for your phenotype
Six licensed monoclonal antibodies, one right answer. We match omalizumab, mepolizumab, benralizumab, dupilumab or tezepelumab to your biomarkers, not the other way around.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private biologic programme costs in the UK.
Indicative annual ranges across our partner units, drug plus monitoring. Send your clinic letters and we quote firm figures across two or three options.
In short
A biologic programme in our network: £12,000–£36,000 per year, most on home injection.
| Programme | Indicative range | Schedule | Turnaround |
|---|---|---|---|
| Severe asthma assessment and phenotyping | £800–£1,600 | 60–90 min | Same visit |
| Omalizumab (Xolair) programme, per year | £12,000–£20,000 | SC 2–4 weekly | Ongoing |
| Mepolizumab (Nucala) programme, per year | £14,000–£22,000 | SC monthly | Ongoing |
| Benralizumab (Fasenra) programme, per year | £14,000–£22,000 | SC 8-weekly | Ongoing |
| Dupilumab (Dupixent) programme, per year | £15,000–£24,000 | SC 2-weekly | Ongoing |
| Tezepelumab (Tezspire) programme, per year | £18,000–£28,000 | SC monthly | Ongoing |
| Second-opinion on a current biologic | £350–£600 | 45 min | 48 hours |
Ranges reflect list prices, unit fees and monitoring; PMI cover is common once NICE TA criteria are met. NHS-funded access is available via specialist severe asthma centres such as Royal Brompton, Guy's and St Thomas', Imperial and King's.
The journey
From referral to home injection, step by step.
One team from first message to your six-month reassessment, including the phenotyping workup and the switch, if that is what the data show.
- 01 Before
You send us your clinic letters and spirometry
A short, confidential form. ACT score, exacerbation history, oral steroid courses in the last year, current inhaler, blood eosinophils, total IgE and FeNO if known.
- 02 Before
We come back with a phenotyping plan
Within one working day: which biologic pathway fits, what workup is still missing (HRCT, ABPA screen, ANCA, adherence check), and an indicative price for the year.
- 03 Before
MDT review and biologic selection
Severe asthma MDT confirm the diagnosis, exclude mimics, and select the biologic. NICE TA criteria are documented, whether the route is NHS or private self-pay.
- 04 In clinic
First dose in clinic
Loading dose given under observation. Anaphylaxis is rare but planned for. You stay 60 minutes after the injection on day one.
- 05 In clinic
Home injection training
Mepolizumab, benralizumab, dupilumab and tezepelumab move to home injection once tolerance is confirmed. A nurse teaches the pen or prefilled syringe technique.
- 06 After
Reassessment at 4 and 6 months
Exacerbation count, oral steroid use, ACT, spirometry and biomarkers reviewed. Non-responders switch pathway rather than stay on a drug that is not working.
- 07 After
Step-down and long-term review
After a year of good control, high-dose ICS is cautiously reduced. Six-monthly reviews continue for as long as the biologic runs.
When it helps
When a biologic is the right step, and when it is not.
The clinical patterns we see most, plus the mimics we screen for before committing to a year of therapy.
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Uncontrolled on GINA step 5
High-dose ICS + LABA, still ACT below 20, FEV1 below 80% predicted, or two or more oral steroid courses in the last year.
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T2-high, eosinophilic
Blood eosinophils above 150 to 300 cells per microlitre and FeNO above 25 ppb. Mepolizumab, benralizumab, reslizumab and dupilumab all fit.
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T2-high, allergic (IgE mediated)
Perennial aeroallergen sensitisation with a raised total IgE. Omalizumab is the classical anti-IgE option, dupilumab a broader alternative.
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Type 2 with nasal polyps or eczema
CRSwNP or atopic dermatitis alongside asthma. Dupilumab treats all three from one injection and is often the pragmatic first choice.
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T2-low, non-eosinophilic
Smoker, obese or neutrophilic phenotype. Tezepelumab, licensed regardless of phenotype, has shifted the ceiling for this group.
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Steroid-dependent asthma
On maintenance oral prednisolone. Benralizumab (ZONDA) and dupilumab (VENTURE) both reduce OCS dose by around 75% in trials.
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Frequent A&E attendances or admissions
Two or more exacerbations a year needing systemic steroids, or any hospital admission with asthma, meets the NICE severity threshold.
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Red flag: something other than asthma
ANCA-positive vasculitis (EGPA), ABPA, bronchiectasis, vocal cord dysfunction and cardiac dyspnoea all mimic severe asthma. Screened before any biologic is started.
The options
Six biologics, one phenotype, one right answer.
What each licensed monoclonal antibody actually does, and where it fits. Exacerbation reduction: mepolizumab around 50%, benralizumab 40 to 70%, dupilumab 46% (LIBERTY QUEST), tezepelumab 56% (NAVIGATOR).
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Omalizumab (Xolair, anti-IgE)
NICE TA278. Severe allergic asthma with a positive skin prick or specific IgE. SC every 2 or 4 weeks, weight and IgE dosed. The longest safety record of the class.
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Mepolizumab (Nucala, anti-IL5)
NICE TA671. Blood eosinophils at or above 300 cells per microlitre. 100 mg SC monthly, home injection after training. Around 50% exacerbation reduction.
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Reslizumab (Cinqaero, anti-IL5)
NICE TA479. IV weight-based, given in day-unit. Useful when a monthly hospital visit suits the patient better than a home injection.
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Benralizumab (Fasenra, anti-IL5Rα)
NICE TA565. Eosinophilic severe asthma. 30 mg SC 8-weekly after three loading doses. Depletes eosinophils rapidly and reduces exacerbations by 40 to 70%.
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Dupilumab (Dupixent, anti-IL4Rα)
NICE TA751. Type 2 asthma, also atopic dermatitis and CRSwNP. 300 mg SC every 2 weeks at home. First choice when nasal polyps sit alongside the asthma.
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Tezepelumab (Tezspire, anti-TSLP)
NICE TA895 (2024). Severe asthma regardless of phenotype. 210 mg SC monthly. A genuine option for the T2-low group who had almost nothing before.
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Bronchial thermoplasty
A non-drug option for a small subgroup. Bronchoscopic radiofrequency to airway smooth muscle. Reserved for cases where biologics have not worked.
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Second-opinion review
A specialist review of your clinic letters, spirometry and biomarkers when a biologic has been declined or is not delivering the promised benefit.
Our vetted UK network
A small panel of severe asthma physicians, we picked them.
Consultants at Royal Brompton, Chelsea and Westminster, HCA Wellington Chest, Guy's and St Thomas', Imperial Charing Cross and King's. Introductions are made privately once we understand your case.
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Severe asthma consultants in tertiary centres with a formal MDT
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Access to full phenotyping: FeNO, sputum induction, ABPA and ANCA workup
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Home injection training and 24/7 respiratory advice line
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Willingness to switch biologic if the primary choice does not respond
Safety and monitoring
What to expect on treatment, honestly.
Biologics are well tolerated. The things worth planning are the first-dose observation, the injection site reactions, the vaccines and the six-monthly response review.
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Anaphylaxis is rare but real
Roughly 0.1 to 0.2% for omalizumab, lower for the newer agents. First doses are given under observation. You carry adrenaline for the omalizumab programme.
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Injection site reactions
Redness, swelling and itch at the injection site are the commonest side effect and usually settle within 48 hours. Rotate sites and use a cold pack.
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Helminth infection screening
Eosinophils fight parasites. Before mepolizumab, benralizumab or reslizumab we screen if you have lived in an endemic area, and treat any latent infection first.
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Conjunctivitis with dupilumab
Around 8 to 10% of patients get a mild conjunctivitis on dupilumab. Managed with lubricants; ophthalmology involved if it does not settle.
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Do not stop your inhaler
Biologics are added on. High-dose ICS and LABA continue for at least a year, then a careful step-down is trialled if control is stable.
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Adherence check first
A FeNO suppression test or a two-week electronic inhaler trial excludes non-adherence before an expensive biologic is committed to.
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Vaccination
Annual influenza, five-yearly pneumococcal and up-to-date COVID vaccines are advised. Live vaccines are avoided while on biologic therapy.
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Red flags after a dose
Wheeze, throat tightness, facial swelling, a rash or dizziness in the hours after an injection need urgent review. Call the unit or 999 for airway symptoms.
Reading your biologic plan
Your treatment plan, in four parts.
Whichever biologic is chosen, the plan letter the consultant sends keeps to the same shape.
- 01 Header
Phenotype and eligibility
Which NICE TA is being used, eosinophil count, FeNO, total IgE and specific sensitisations, ACT and ACQ scores, spirometry.
- 02 Plan
Biologic, dose and schedule
Which drug, the loading regimen, the maintenance interval, whether home injection is intended and when the switch happens.
- 03 Safety
Comorbidities, screening and vaccines
CRSwNP, atopic dermatitis, EGPA and ABPA workup, helminth screen if relevant, and the vaccination checklist.
- 04 Follow-up
Response criteria and stopping rules
What counts as a response at 4 and 6 months, when to switch biologic, and when to consider step-down of ICS after a year.
Recognised by major UK insurers
Cover for biologics is common once NICE TA criteria are met. We confirm cover with your insurer before the loading dose.
Frequently asked
Everything we get asked about asthma biologics.
Quick answers on eligibility, cost, home injection and how quickly a biologic starts to work.
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What counts as severe asthma?
Asthma that stays uncontrolled despite high-dose inhaled corticosteroids plus a long-acting beta agonist (GINA step 5), with two or more oral steroid courses in the last year, an ACT below 20 or FEV1 below 80% predicted. Around 3 to 5% of adult asthma is severe in this technical sense.
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How do you decide which biologic I need?
By phenotyping. Blood eosinophils, FeNO, total IgE and specific allergen sensitisation split severe asthma into T2-high allergic, T2-high eosinophilic and T2-low groups. Comorbidities matter too: nasal polyps or atopic dermatitis often push us towards dupilumab, tezepelumab covers the T2-low patient.
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How much does a private biologic cost per year?
List prices run £8,000 to £28,000 per year for the drug alone. Private self-pay programmes in London, including monitoring and consultations, sit at £12,000 to £36,000 per year. Most PMI policies will cover a biologic once NICE criteria are met.
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Can I self-inject at home?
Yes, for mepolizumab, benralizumab, dupilumab and tezepelumab, once the first doses have been given under observation and a nurse has trained you on the pen or prefilled syringe. Omalizumab and reslizumab stay clinic-administered.
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How quickly will it work?
Symptom control often improves within 4 to 8 weeks. The reduction in exacerbations is judged formally at 4 and 6 months. If there is no meaningful response by 6 months we switch biologic rather than persevere.
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Do I stop my inhaler if the biologic works?
No. Biologics are added to, not swapped for, inhaled therapy. After a year of good control we may reduce the ICS dose in careful steps, but a long-acting bronchodilator almost always continues.
Ready to be matched?
Send us your clinic letters. We come back within a working day.
Confidential, free, and impartial. A named severe asthma consultant, the right biologic for your phenotype, and a plan you can hold your GP and insurer to.
Related
Looking for something else?
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Spirometry and lung function
The baseline test before any biologic decision.
Learn more -
Bronchoscopy
For mimics: bronchiectasis, ABPA, foreign body.
Learn more -
Bronchial thermoplasty
Non-drug alternative in a small subgroup.
Learn more -
Chronic cough clinic
Where cough dominates over wheeze.
Learn more -
Dupilumab for atopic dermatitis
Same drug, other indication.
Learn more -
Omalizumab for chronic urticaria
Anti-IgE beyond asthma.
Learn more -
Asthma condition guide
The wider patient guide.
Learn more -
Nasal polyps
CRSwNP often sits alongside T2 asthma.
Learn more -
All treatments
Every treatment we arrange.
Learn more -
Send Enquiry
Tell us your case and we come back within a working day.
Learn more