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Asthma SABA overuse — GPhC CRA MCQ

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HardRespiratory TherapeuticsAsthma SABA overuseGPhC CRA

A 36-year-old has episodic wheeze and nocturnal cough. Blood eosinophils are within range and FeNO is 31 ppb. Pre-bronchodilator FEV1 is 2.50 L and rises to 2.84 L after bronchodilator; predicted FEV1 is 3.10 L. Technique and test quality are acceptable. How should these results be interpreted under NICE NG245?

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Correct answer: C — The increase of 340 mL and 13.6% confirms asthma by bronchodilator reversibility

When eosinophils and FeNO do not confirm asthma, NICE proceeds to spirometry with bronchodilator reversibility. Here FEV1 rises by 0.34 L: 340 mL and 13.6% of baseline, exceeding both the 200 mL and 12% thresholds. A normal eosinophil count or FeNO below 50 ppb does not exclude asthma. NICE does not require a universal 400 mL change or 30% peak-flow variability. The pattern demonstrates variable airflow obstruction and does not itself establish COPD.

Reference: NICE NG245: Asthma diagnosis, monitoring and chronic management. https://www.nice.org.uk/guidance/ng245/chapter/recommendations