Injection beats steroids for asthma and COPD attacks in first major advance in 50 years

A single injection has outperformed steroid tablets for treating acute asthma and COPD attacks in a clinical trial — the first treatment in roughly half a century to improve on a standard of care that hasn’t changed since the 1970s. Researchers say the finding could reshape how emergency respiratory care works for hundreds of millions of patients around the world.

At a glance

• Benralizumab injection: A single high-dose injection of this monoclonal antibody outperformed steroid tablets at both 28 and 90 days, with four times fewer treatment failures in the benralizumab group by the three-month mark.
• COPD and asthma flare-ups: The trial targeted eosinophilic exacerbations — the biological subtype behind roughly 50% of asthma attacks and 30% of COPD attacks — identified using a rapid blood test in the emergency department.
• Treatment failure rate: Patients receiving benralizumab needed 30% fewer follow-up medical interventions than those on standard steroid care, and reported better quality of life throughout the study period.

Why this matters

Asthma and COPD together cause an estimated 3.8 million deaths worldwide every year. COPD alone is the third leading cause of death globally.

Yet the standard treatment for acute attacks — a short course of oral corticosteroids — has gone largely unchanged since the 1970s C.E. Steroids carry real long-term risks, including elevated chances of developing diabetes and osteoporosis. A treatment that achieves better outcomes without those side effects would mark a genuine shift in emergency respiratory medicine.

Dr. Samantha Walker, director of research and innovation at Asthma and Lung UK, welcomed the findings while noting a harder truth: the 50-year gap is itself a sign of how severely underfunded lung health research has been.

How the trial worked

The study, published in Lancet Respiratory Medicine in November 2024 C.E., enrolled 158 patients who sought emergency care for an asthma or COPD attack at Oxford University Hospitals NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust. The trial was led by King’s College London.

Patients received a quick blood test to determine whether their attack was eosinophilic. Those who were positive were then randomly assigned to one of three groups: benralizumab injection plus a placebo tablet, standard steroid tablets plus a placebo injection, or both treatments together.

The benralizumab groups outperformed steroids alone on every key measure — symptom scores at 28 days, treatment failure rates at 90 days, and patient-reported quality of life. The drug works by targeting eosinophils, specific white blood cells that drive lung inflammation during these kinds of attacks.

A known drug, deployed in a new way

One of the most striking aspects of this finding is that benralizumab isn’t new. It’s already approved and in clinical use — at lower doses — as a maintenance therapy for severe asthma. What changed here is the timing and dosage strategy: a single high dose administered during an attack, rather than between them.

That matters for how quickly this could move from research to real-world use. An established safety profile means fewer regulatory unknowns.

Lead investigator Professor Mona Bafadhel of King’s College London led the research. First author Dr. Sanjay Ramakrishnan, clinical senior lecturer at the University of Western Australia, put the stakes plainly: “COPD is the third leading cause of death worldwide but treatment for the condition is stuck in the 20th century. We need to provide these patients with life-saving options before their time runs out.”

AstraZeneca provided the drug and funded the research, though the researchers confirmed the company had no involvement in trial design, analysis, or interpretation.

What still needs to happen

The trial was relatively small at 158 participants, and larger confirmatory studies will be needed before benralizumab becomes a standard emergency treatment. Questions around equitable access — particularly in lower-income countries where COPD mortality is highest — remain unresolved, and regulatory approval pathways are still ahead.

Still, for the millions of people who have sat in emergency rooms struggling through a COPD or asthma attack, a more effective treatment with fewer side effects — one that could eventually be administered at a GP’s office or even at home — would be a meaningful change in what their lives look like. This kind of progress connects to a broader shift in medicine: moving from blunt, systemic treatments toward targeted interventions that address specific biological mechanisms, the same logic driving advances in Alzheimer’s prevention research.

Read more

For more on this story, see: Respiratory Therapy

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• The Good News for Humankind archive on global health

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