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Acute asthma severity assessment — GPhC CRA MCQ

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ModerateRespiratory TherapeuticsAcute asthma severity assessmentGPhC CRA

A 40-year-old man with severe asthma on high-dose ICS/LABA combination and montelukast presents to the pharmacy reporting increased breathlessness and wheeze over 2 days. He has been using his salbutamol inhaler every 2 hours. His peak flow is 55% of his best. What is the most appropriate action?

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Correct answer: E — Recommend he attends A&E immediately

A peak flow of 55% of best with increasing symptoms despite frequent reliever use represents a moderate-to-severe asthma exacerbation requiring emergency assessment. BTS/SIGN guidelines classify peak flow 50-75% as moderate acute asthma, but in the context of frequent reliever use in a patient with severe background asthma, urgent medical assessment is needed. A peak flow below 50% or failure to respond to bronchodilator should prompt emergency department attendance.

Reference: BTS/SIGN 158 Asthma; NICE NG80