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Severe eosinophilic asthma — SCE Respiratory MCQ

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HardAsthmaSevere eosinophilic asthmaSCE Respiratory

A 42-year-old woman with lifelong asthma is reviewed after two prednisolone-treated attacks in 8 months. She uses high-dose budesonide/formoterol MART correctly, has FeNO 68 ppb, blood eosinophils 0.72 x 10^9/L and pre-bronchodilator FEV1 62% predicted. CT chest is normal and adherence is confirmed electronically. What is the most appropriate management?

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Correct answer: B — Refer for severe asthma phenotyping and biologic assessment

This patient has uncontrolled type 2-high asthma despite optimised high-dose inhaled therapy, confirmed adherence and recurrent exacerbations, so specialist severe asthma phenotyping for biologic eligibility is the best next step. Theophylline is a weaker add-on and would not address the exacerbation burden as effectively. Maintenance oral corticosteroids are avoided where possible because of toxicity; bronchial thermoplasty is not the initial escalation in this phenotype.

Reference: BTS/NICE/SIGN Asthma Guideline NG244; ERS/ATS severe asthma guidance