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Asthma — RACP Adult Medicine MCQ

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ModerateRespiratoryAsthmaRACP Adult Medicine

A 50-year-old man with moderate persistent asthma is well-controlled on low-dose ICS/formoterol maintenance and reliever therapy. He asks about stepping down. His ACQ score is 0.5 and he has had no exacerbations for 12 months. What is the most appropriate step-down strategy?

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Correct answer: D — Low-dose ICS/formoterol PRN alone

For patients on low-dose ICS/formoterol MART who are well-controlled for ≥3 months, step-down to ICS/formoterol as-needed only (SMART approach) is appropriate. The SYGMA trials support formoterol/budesonide PRN as maintenance strategy. Complete cessation of ICS is not recommended due to relapse risk.

Reference: Australian Asthma Handbook – 2024; GINA 2024