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Severe Asthma — RACP Adult Medicine MCQ

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HardRespiratorySevere AsthmaRACP Adult Medicine

A patient remains symptomatic with frequent exacerbations on high-dose ICS/LABA. Technique and adherence are verified, FeNO is 55 ppb and eosinophils are 600 cells/microlitre. What is the next step?

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Correct answer: B — Refer for severe-asthma phenotyping and biologic eligibility assessment while addressing comorbidities and steroid exposure

The best answer is “Refer for severe-asthma phenotyping and biologic eligibility assessment while addressing comorbidities and steroid exposure”. Persistent uncontrolled disease after verified high-dose therapy requires confirmation of diagnosis, exacerbation burden and comorbidity plus specialist type-2 phenotyping. Raised eosinophils and FeNO can support anti-IgE, anti-IL5/IL5R or anti-IL4R therapy depending on the whole phenotype. Biologics reduce exacerbations and oral-steroid exposure; they do not justify stopping inhaled controller treatment immediately.

Reference: Australian Asthma Handbook: Specialist assessment and treatment for severe asthma: https://www.asthmahandbook.org.au/management/adults-and-adolescents/medication-management/specialist-assessment-and-treatment-for-severe-asthma-in-adults-and-adolescents