ENMost people with asthma live well with inhalers prescribed at home. Asthma treatment in Germany makes sense when that is not the case: attacks keep returning, one course of steroid tablets follows another, nights are disturbed, emergency visits recur — or it is not even certain that the problem is asthma.
Below: severe versus difficult-to-control asthma, tests, treatment steps up to biologics, specialists and travel arrangements. The page covers adults; for children with asthma, see treatment for children in Germany.
Is it really asthma, and is it severe?
Poorly controlled asthma is not always severe, and sometimes it is not asthma at all. In difficult-to-control asthma, other factors block control, and dealing with them may settle the asthma noticeably. It counts as severe only if it stays uncontrolled despite correctly taken high-dose inhaled steroids plus a second long-acting medicine, with aggravating factors managed.
First come the simple causes: an unsuitable inhaler or faulty technique, irregular use, ongoing triggers such as tobacco smoke or allergens at home or work. Accompanying conditions also worsen asthma: chronic sinusitis with nasal polyps, reflux, excess weight and sleep apnoea — pauses in breathing during sleep.
Other conditions can mimic asthma: vocal cord dysfunction, where the cords close on breathing in; COPD, a chronic lung disease mostly of long-term smokers; and heart causes of breathlessness such as heart failure. So a pulmonologist checks the diagnosis before intensifying treatment.
Tests at a pulmonology centre
A pulmonology centre tests lung function, looks for inflammation markers and orders imaging if needed. Spirometry, measuring how much and how fast you breathe out, is done before and after inhaling a bronchodilator; clear improvement supports asthma. Body plethysmography shows airway resistance and the air left in the lungs. If results are normal on the day, a provocation test may follow: under medical supervision, the patient inhales a substance that narrows sensitive airways.
Markers of inflammation point to the type of asthma. FeNO, the amount of nitric oxide in exhaled air, signals a certain type of airway inflammation; blood tests show eosinophils, a type of white blood cell, and total IgE, antibodies involved in allergic reactions. Suspected allergy is checked with skin or blood tests — see allergy treatment.
Imaging is used only when needed: chest CT to rule out other lung diseases, sinus CT for nasal complaints. Bring previous reports and every inhaler you use; the doctor will ask you to demonstrate your technique.
Treatment: from the right inhaler to biologics
Treatment works in steps: it is stepped up when asthma is uncontrolled and carefully reduced after several months of good control. This follows the German national care guideline, the Nationale VersorgungsLeitlinie Asthma, now in version 5. Before any step up, the inhaler is reviewed: it should suit the patient’s breathing strength and skills, and technique is taught and rechecked regularly. Every patient should have a written action plan for flare-ups.
Biologics are for severe asthma that stays uncontrolled even on maximum inhaled therapy, prescribed by a pulmonologist experienced in treating it. These monoclonal antibodies block specific inflammatory signals: omalizumab targets IgE, mepolizumab and reslizumab interleukin-5, benralizumab its receptor, dupilumab the receptor for interleukins 4 and 13, tezepelumab TSLP, a protein involved in airway inflammation. In the EU all six are approved as add-on treatment: omalizumab for severe allergic asthma with proven sensitivity to a year-round airborne allergen; mepolizumab, reslizumab and benralizumab for severe eosinophilic asthma; dupilumab for type 2 inflammation with raised blood eosinophils and/or FeNO; tezepelumab without a specified type of inflammation. Reslizumab and benralizumab are approved for adults only, tezepelumab from 12 years, omalizumab, mepolizumab and dupilumab from 6 years. Put simply, these are injections under the skin every few weeks (reslizumab is a drip into a vein), chosen by the inflammation type found in tests and assessed after several months. Existing treatment continues and is reduced only after clear improvement; without improvement, the biologic is stopped.
For allergic asthma with a clearly identified trigger, the doctor considers allergen immunotherapy, a gradual desensitisation. Under the German guideline, pulmonary rehabilitation — breathing and exercise training with education — should be considered before a biologic.
Pulmonologists and clinics for asthma
Prof. Joachim Ficker, chief physician of pulmonology at Klinikum Nürnberg, holds additional qualifications in allergology and sleep medicine — useful when allergy or sleep apnoea accompanies asthma. Prof. Rembert Koczulla is chief physician of the pulmonology centre at Schön Klinik Berchtesgadener Land. Prof. Martin Hetzel is medical director of the Department of Pulmonology and Ventilation Medicine at Klinikum Stuttgart.
For an overview of lung diseases, tests and hospitals, see pulmonology in Germany. Choose a hospital by the task — confirming the diagnosis, selecting a biologic or rehabilitation — not by a ranking.
Frequently asked questions
Can asthma be cured completely?
No, asthma cannot be cured, but it can be controlled: rare daytime symptoms, no waking at night, little need for the reliever inhaler and no limits on daily life. After several months of stable control, the doctor may carefully reduce treatment; stopping steroid medicines on your own is risky.
Can I stop my asthma inhalers once I start a biologic?
Not at first. A biologic is added to existing treatment, not given instead of it; inhaled therapy is reduced only after asthma control clearly improves, under close monitoring. Whether lower doses will be enough later cannot be predicted. A reliever inhaler always stays within reach.
How much does asthma treatment in Germany cost?
The hospital states the exact amount in an official cost estimate (Kostenvoranschlag) after a pulmonologist has reviewed your documents. It depends on the tests needed, on outpatient visits versus a hospital stay, and on whether a biologic is prescribed — such treatment is expensive and long-term. You get the estimate before travelling.
How AlenMed arranges asthma treatment in Germany
AlenMed organises everything except the treatment itself. Before the trip we translate your reports, lung function results and medicine list; a pulmonologist reviews them and proposes a plan — several days of outpatient tests or a short hospital stay — and the hospital sends an official cost estimate (Kostenvoranschlag). See arranging treatment in Germany.
Travel only when stable, with inhalers and your action plan in hand luggage. We provide the visa invitation, help with accommodation and arrange an interpreter for appointments. AlenMed’s office is in Munich; partner hospitals are across Germany.
Back home, you receive a report in your language and a written plan for your doctor. Biologic injections, if prescribed, continue at home in agreement with your local doctor.
This material is for reference only and is not an offer; treatment is decided by a doctor after an in-person examination.