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Severe eosinophilic asthma — SCE Respiratory MCQ

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HardAsthmaSevere eosinophilic asthmaSCE Respiratory

A 51-year-old man with difficult asthma remains symptomatic despite high-dose inhaled corticosteroid, long-acting beta2 agonist, long-acting muscarinic antagonist and good inhaler technique. He has had four prednisolone-treated attacks in 12 months, blood eosinophils are 0.72 x 10^9/L and FeNO is 64 ppb. Total IgE is low and perennial allergen testing is negative. What is the most appropriate specialist add-on treatment?

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Correct answer: D — Anti-interleukin-5 pathway biologic therapy

The biomarker profile and recurrent exacerbations suggest severe eosinophilic type 2 asthma, making an anti-IL-5 pathway biologic such as mepolizumab or benralizumab the best option. Omalizumab is more appropriate for severe allergic asthma with relevant IgE sensitisation. Maintenance prednisolone has substantial toxicity and should not be preferred when steroid-sparing biologics are appropriate.

Reference: NICE TA671; NICE TA565; BTS/NICE/SIGN Asthma Guideline 2024