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Adult asthma diagnosis and initial treatment — SCE Respiratory MCQ

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ModerateAsthmaAdult asthma diagnosis and initial treatmentSCE Respiratory

A 29-year-old woman has episodic wheeze and nocturnal cough. Spirometry is normal between episodes. FeNO is 72 ppb and blood eosinophils are 0.45 x 10^9/L. She has no smoking history and no alternative diagnosis on examination. What is the most appropriate management?

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Correct answer: E — Start low-dose ICS-formoterol anti-inflammatory reliever therapy

High FeNO and eosinophilia support type 2 airway inflammation in a compatible clinical presentation, so starting inhaled corticosteroid-containing treatment is appropriate. SABA-only treatment is no longer preferred because it does not treat airway inflammation and is associated with exacerbation risk. CTPA and maintenance prednisolone are not justified by this stable presentation.

Reference: BTS/NICE/SIGN Asthma Guideline NG244