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Severe eosinophilic asthma — SCE Respiratory MCQ

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HardAsthmaSevere eosinophilic asthmaSCE Respiratory

A 42-year-old teacher has episodic wheeze and cough despite regular budesonide/formoterol maintenance and reliever therapy. Spirometry shows FEV1 72% predicted, FEV1/FVC 0.68 and 16% bronchodilator reversibility; FeNO is 78 ppb and blood eosinophils are 0.62 × 10^9/L. She has had four prednisolone-treated attacks in the past year, uses good inhaler technique, and has no ongoing smoking exposure. CT chest is normal apart from mild bronchial wall thickening. What is the most appropriate management?

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Correct answer: E — Refer to severe asthma MDT for anti-IL-5 or anti-IL-4R assessment

The history shows uncontrolled asthma despite optimised inhaled therapy with a type 2 inflammatory phenotype, so specialist severe asthma assessment for biologic eligibility is best. Simply escalating inhaled steroid dose is tempting, but she has already had recurrent severe attacks and needs phenotyping, adherence review and MDT assessment. Maintenance oral corticosteroids may reduce attacks but carry substantial toxicity and should not precede specialist biologic consideration.

Reference: BTS/NICE/SIGN Asthma Guideline 2024; NICE severe asthma technology appraisals