PAs and severe asthma: Overcoming practice barriers and utilizing emerging therapies to improve patient outcomes

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October 30, 2026

By AAPA Research

Asthma affects more than 25 million Americans each year, and within that population 5-10% of patients are living with severe asthma.¹ Biologic therapies have been used to treat asthma for almost two decades, and The Global Initiative for Asthma (GINA) guidelines were updated in 2019 to include biologics in the stepwise model for the first time.² While there is no cure for the condition, new treatment options could substantially reduce some of the direct and indirect burden patients with asthma face.

The physician associate (PA) role in asthma treatment includes providing specialty-level longitudinal care within a healthcare team. AAPA gathered a group of 14 PAs from the PA Insights Network to hear their thoughts on how emerging treatment methods, educational resources, and barriers to care are impacting their patient populations.

What role are PAs playing in the treatment of patients with severe asthma?
PAs encounter patients with severe asthma across a wide variety of clinical settings and specialties. PAs actively identify, manage, and coordinate care for patients with asthma — from initial referrals and ongoing primary care management to diagnosis and treatment in pulmonology, allergy and immunology, and pediatric subspecialties. According to subject matter expert Brian Bizik, MS, PA-C, DFAAPA, over the past 10–15 years, the role of PAs in pulmonary medicine has evolved significantly. PAs are not only managing traditional inhaled therapies but also identifying phenotypes and treatable traits; evaluating patients for advanced therapies; and initiating and monitoring biologic and other emerging evidence-based treatments. An important part of this care management is uncovering asthma severity and appropriately escalating patients to advanced therapies in a timely fashion for optimal health outcomes.

However, patient adherence to treatment for severe asthma can pose a challenge in managing the disease. Many factors, from lifestyle habits and social determinants of health to identifying the correct timing for additional pharmacologic interventions, add difficulties. These struggles are exacerbated in rural practice settings where patients can often experience long delays between their primary care appointment and a specialty referral. However, even focus group participants from more metropolitan areas reported patients encountering wait-time delays after being referred to asthma specialists. PAs have a unique opportunity to assist in the mitigation of many of these patient barriers by expanding their knowledge related to the management of severe asthma.

When asked to describe their experiences diagnosing and managing asthma in their patients, many participants stressed that they are often developing effective action plans while simultaneously educating their patients on the importance of keeping up with their treatment. When discussing strategies for maintaining treatment adherence, a pediatric pulmonology PA said, “I want [the patient] to understand that this is a serious disease and that they need to be on board with what I’m doing — otherwise it will not work.” Similarly, a different PA highlighted that they “try to be their biggest cheerleader” by both encouraging commitment to a care plan and reminding patients that additional complications, like flare-ups and airway remodeling, can happen if asthma is not effectively managed. Being aware of newer biologic treatments for asthma with longer dosing intervals was also cited by focus group participants as an important factor when trying to secure patient buy-in for initiating or persisting with a treatment plan.

While severe episodes are managed within specialty settings, PAs in primary care also play a role in helping their patients with asthma. Ensuring patients are on the right treatment plan before encountering complications that reduce their quality of life or increase their asthma-related healthcare expenditure is critical to assuring optimal outcomes for patients with severe asthma. As a PA in internal medicine explained, “I’m trying to explain to them why it would be beneficial so that we prevent further exacerbations from happening.”

Focus group participants practicing in primary care expressed that having more knowledge helped them identify when and to whom patients should be referred, but they were not as familiar with newer options of asthma treatment as specialist PAs. Part of this gap may come from differences in access to information. Several specialist participants named pharmaceutical representatives, scientific conferences, and speaker programs as key sources for staying current on biologics. As the previously quoted internal medicine PA explained, “Summaries of new medication would be so beneficial to primary care.” An additional primary care PA added that she often defers to specialists on questions about biologics because she is unsure how asthma biologics differ from those used for rheumatologic conditions.

New biologic options and asthma management
While biologic therapies can help effectively manage severe asthma, treatment adherence can be particularly challenging. Based on a retrospective cohort study with claims data, more than half of patients who initiated biologic therapy for asthma between 2007 and 2023 discontinued their treatment within 12 months.³ In the same study, patients who were less adherent to biologics had higher rates of asthma exacerbations, leading to higher rates of hospital visits compared to adherent patients. Within our recent focus groups, PAs also experienced differing levels of familiarity, comfort, and adherence with biologics in their patient populations that affected their approaches to managing severe asthma.

When encountering patients who had been referred to them after their asthma had escalated, specialist PAs reinforced the importance of timely initiation of biologic therapies for patients with severe asthma. As a PA in pulmonology highlighted, “I use biologics as often as I can in patients recently discharged from the hospital that have the biomarkers that would indicate that that would help keep them from rebounding back into the hospital.” Other PAs echoed the importance of getting a phenotype of the patient and performing additional tests to ensure an effective treatment plan; however, PAs also shared that patients can be apprehensive to start these therapies due to barriers like insurance coverage, medication cost, and logistical concerns.

As explained by another pulmonology PA, “I work in rural Nebraska . . . [with] a large Medicaid, Medicare population. So coverage is a big issue.” Others mentioned that even if approved through private insurance, patients can still fail to adhere to their treatment plan, due to wait times and out-of-pocket costs of biomarker tests as well as the therapy itself. Additionally, while some of these therapies are eligible for self-injection, others must be administered within a clinical setting. This logistical step can create an additional hurdle for patients who do not have reliable access to transportation. Even when medication is eligible for self-injection, many PAs in our discussions emphasized the hurdles patients encounter when coordinating with specialty pharmacies for delivery. For example, patients who have less experience with specialty pharmacies may not be aware that they are responsible for follow-up conversations related to scheduling medication and ensuring their next dose is delivered to the right location — whether that be their own home or a clinician’s office.

Overcoming barriers to initiation, adherence, practice
Recent research suggests many patients who may be eligible for biologic therapy are not getting it. Despite the availability of seven biologics, approximately 20% of eligible patients at GINA treatment step 5 in a recent analysis of U.S. claims data received biologic therapy. Patients at GINA step 4 carried a disease burden similar to those at step 5; for example, about one-third of each group had an asthma-related emergency department visit.⁴ Waiting until GINA step 5 to consider a biologic may leave a group of high-burden patients without advanced therapy.

In our discussion, PAs provided solutions they have implemented to help address patients’ barriers and mitigate their risk of nonadherence:

• Setting expectations for follow-up. A pulmonary PA tells patients that “if they haven’t heard from [the pharmacy providing the biologic] within a week to let our office know.” She found that patients were otherwise getting lost between approval and shipment, and reminding patients to check back can reduce the chances that they fail to initiate treatment.
• Warning patients about the logistics up front. An allergy PA in Boston reminds new patients, “You have to pick up the phone to confirm your address, otherwise they will not ship it to you.” Many PAs stressed that often, patients might not be as familiar with administration of these therapies during their initial consultations.
• Care coordination. A pulmonary PA in Nevada pairs high-risk patients, including patients experiencing homelessness, with a nurse navigator. His practice also partners with an infusion center, so the medication can be sent there instead of to a home address.
• Administrative support. Where practices have biologic coordinators or a specialty pharmacy handling prior authorizations, PAs said it lifted “a significant administrative burden” from both the office and the patient. Participants without that support felt the gap. As a PA in rural Washington shared, “I have to do a lot of the approval process myself or with the help of an RN/MA.”

Impact of long-acting biologics
Recent clinical trials have illustrated the impact new biologics with longer times between injections, such as depemokimab, can have within this patient population. In the SWIFT-1 and SWIFT-2 trials, twice-yearly depemokimab reduced the annualized exacerbation rate by about half for severe asthma patients compared with a placebo.⁵ The proportion of patients with any adverse event was similar in the two groups in both trials. The authors of the study noted therapies dosed less often are associated with a lower patient-reported treatment burden.⁴

Focus group participants tied this dosing schedule directly to the aforementioned barriers. One allergy PA described three patients who had struggled with regular injections: “One is homeless, one is a truck driver, and one is very, very non-adherent . . .  They’ve been okay with being able to make it to the office twice a year.” A PA in Georgia noted that Medicaid transport must be booked days in advance, so a twice-yearly schedule is “a lot easier” to arrange than dosing every two weeks. A pediatric pulmonary PA pointed to children in split households and foster care as likely beneficiaries. While few PAs who participated in the discussion had previously prescribed this new biologic, they were optimistic that it could help address many of the challenges their patients encounter.

What can PAs do to make a difference?
Participants described adherence as ongoing work that continues after the prescription. PA Bizik summarized how “once a patient gets going on a biologic, it can be difficult to keep the prescription going.” Most biologics require the patient to “approve” the refills, contact the pharmacy monthly, or call the pharmacy on a periodic basis to keep the prescription going. This can add more logistical hurdles over traditional treatment methods like inhalers.

PAs in our discussion aimed to keep patients engaged by making progress visible. One pediatric PA does spirometry at every visit, and another PA aimed to gamify recurrent visits by grading children’s breathing tests, “just like they do at school.” PAs also set realistic expectations for their patients about how long a biologic takes to show benefit. The PAs we talked to also stressed the importance of all PAs in primary care or specialty practice supporting patients with asthma in simple, consistent ways — like checking inhaler technique and following up after hospital discharge.

When asked about what information could support future education on asthma, PAs asked for short, practical resources rather than more promotional material. Some examples include:

• Concise clinician summaries. A pediatric pulmonary PA said she didn’t need a “10-page pamphlet,” just one page highlighting benefits to patients and the end goal. An allergy PA also suggested that alternative modalities like podcasts could serve as a quick reminder of which patient fits which biologic. This resource could also give clinicians the opportunity to learn whenever and wherever it is convenient for them.
• Patient messaging about long-term benefit. A different pulmonary PA now describes biologic therapy to his patients as “an investment in 40, 50, 60-year-old you,” because uncontrolled type 2 inflammation is linked to faster lung function decline. Being able to communicate this message to the caregivers of pediatric patients can also help demonstrate the importance of treatment adherence in managing this disease.
• Links between specialty and primary care PAs. Participants in our discussion proposed using professional organizations to connect PAs in specialty practice with PAs in general and rural practice for consultation and shared learning. Having opportunities to connect and share knowledge — similar to the focus group discussions — can facilitate a transfer of information that supports patients.

These requests strongly align with calls for additional resources, onboarding, and education designed for PAs and other providers to help address unmet needs for asthma and allergy patient populations.⁶

While new biologic treatments like depemokimab have the potential to help patients with severe asthma, it is up to PAs across specialties and practice settings to help identify eligible patients, coordinate referrals, manage care plans, and support persistence within their patient populations. If you are interested in learning more about helping patients with severe asthma, we suggest accessing the Pulmonary/Respiratory section within the AAPA Clinical Resource Library.

Sean Kolhoff is AAPA’s Director of Research. He can be reached at [email protected].

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Sponsored Content: Insights on biologic initiation/adherence from GSK

About the project
This research was sponsored by GSK. The analysis and presentation of information within this article is the work of AAPA.

References
[1] American Lung Association. Severe Asthma: Understand what severe asthma is and how it is diagnosed and treated. 2026. Retrieved from: 110855163

[2] Prabakaran A. Treating asthma in the age of biologics JAAPA. 2020;33(6):48-50. doi:10.1097/01.JAA.0000657220.41861.2d

[3] Lugogo NL, Modena B, Kwiatek J, et al. Consistent adherence to biologic therapies is critical for improving outcomes in asthma. J Allergy Clin Immunol Glob. Published online 2026.

[4] Park J, Gelwicks S, Jacques LA, et al. Biologic underutilization and healthcare burden in US patients with type 2 severe asthma. J Asthma Allergy. 2026;19. doi:10.2147/JAA.S580937

[5] Jackson DJ, Wechsler ME, Jackson DJ, et al. Twice-yearly depemokimab in severe asthma with an eosinophilic phenotype. N Engl J Med. 2024;391(24):2337-2349. doi:10.1056/NEJMoa2406673

[6] Bauer M, Leeds S, Lewis MO, et al. Advanced practice practitioners in allergy and immunology: where are we now and future directions. Ann Allergy Asthma Immunol. 2025;135(6):642-650.e3.