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Severe Asthma Biologic — RACP Adult Medicine MCQ

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ModerateRespiratorySevere Asthma BiologicRACP Adult Medicine

A 55-year-old woman with moderate persistent asthma on ICS/formoterol MART (maintenance and reliever therapy) continues to have poor control (ACT score 14, using reliever 5+ times/week). She has good inhaler technique and adherence confirmed. Blood eosinophils are 450 cells/μL. Total IgE 380 IU/mL. FeNO 55 ppb. What is the most appropriate treatment escalation?

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Correct answer: E — Referral for biologic assessment (anti-IL5 or anti-IgE)

Uncontrolled asthma despite medium-dose ICS/LABA (Step 4) with elevated biomarkers (eosinophils ≥300, FeNO ≥25, elevated IgE) = Type 2-high severe asthma requiring assessment for biologic therapy. Options: anti-IgE (omalizumab — if allergic), anti-IL5/IL5R (mepolizumab, benralizumab — if eosinophilic), anti-IL4Rα (dupilumab — broad Type 2), anti-TSLP (tezepelumab — broadest). Choice depends on phenotype. Australian Asthma Handbook 2024 recommends specialist assessment for biologics.

Reference: Australian Asthma Handbook – 2024; GINA 2024