How effective are injected biologics?

@noisylungs31 What was the purpose of the Levofloxacin therapy? Did he detect any other treatable infection? Do you have Bronchiectasis in addition to Asthma and MAC?

Fasenra is sometimes used to treat severe eosinophilic asthma - how well is your asthma managed with traditional medications? How often do you have exacerbations that don't respond to conservative treatment? Have you been hospitalized for your asthma since it was diagnosed? Have you tried any of the newer inhalers like Symbicort (aka Breyna or formoterol/budesonide)?

Knowing how difficult it is to get drugs approved nowadays, these questions will probably be asked by your insurance carrier because a month of Symbicort costs around $450 compared to $5000 for Fasenra.

I can tell you that my asthma is "mildly" eosinophilic and Symbicort was a game-changer for me. It all but eliminated the need for my rescue inhaler and improved my breathing. In 3 years I have had fewer than 3 exacerbations, and barely need to use my nebulizer to control my asthma (only if I get a respiratory infection.) Biologics are on the "back burner" for me for now.

My understanding is that biologic injectables like Fasenra are used for what you have, severe eosinophilic asthma (high eosinophil levels). On the other hand, Fasenra is not standard treatment for bronchiectasis or MAC. If you have bronchiectasis and MAC, Fasenra is generally not recommended due to concerns about increase of infection risk and immune suppression. So, in other words, based on what I know, you need to be careful using the biologic with an active MAC infection.

Is your pulmonary doctor skilled and experienced in treating MAC/bronchiectasis? The average pulmonologist is not. They see asthma much more frequently than MAC/bronchiectasis. Some general pulmonologists never see MAC/bronchiectasis in their careers, which takes nuance and experience to treat. Have you had a CT scan? X-rays are not powerful enough to show what's really going on in the lungs. Furthermore, Levofoxacin is not a treatment for MAC but rather for other opportunistic infections like pseudomonas, Haemophilus influenzae, Moraxella etc. Have you seen the lab reports on your sputum cultures? The lab usually does a susceptibility test for what grows in the sputum and therefore it helps to determine which antibiotic to use.

Thanks, Sue and Scoop for your comments. Results of sputum submitted on March 20th to test for Mycobacteria take 6 weeks so not known until early May. In the Fall of last year, 2 of the 4 samples showed
Mycobacterium avium complex.
I have appointment at Pulmonary Lab for pulmonary function and nitric oxide tests April 30th. I nebulize with 3% saline daily. Steroids cause severe thrush and voice loss after only 2 days use. I found alternative in Cromolyn sodium. Now this has been "Out of Stock" everywhere. I called the pharma company TEVA to ask about new supply date. Unpredictable!
My Eosinophils result: 920
The normal range of eosinophils is between 0 to 500 cells per microliters or 1 to 4% of your white blood cell count.
Again, I appreciate your input as we wade through the maze of MAC!