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Aspirin-exacerbated respiratory disease — SCE Respiratory MCQ

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HardAsthmaAspirin-exacerbated respiratory diseaseSCE Respiratory

A 42-year-old man has asthma, chronic rhinosinusitis and recurrent nasal polyps. He develops wheeze, flushing and rhinorrhoea within 40 minutes of taking ibuprofen for back pain. Spirometry between attacks shows mild airflow obstruction with reversibility. What is the most likely underlying cause?

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Correct answer: A — COX-1 inhibition with excess cysteinyl leukotriene activity

The best answer is “COX-1 inhibition with excess cysteinyl leukotriene activity”. The clinical pattern, physiology and imaging described are most consistent with COX-1 inhibition with excess cysteinyl leukotriene activity. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“IgE-mediated allergy to beta-lactam antibiotics”, “Alpha-1 antitrypsin deficiency, after specialist assessment”, “Defective mucociliary clearance, within a respiratory pathway”, “Vocal cord adduction triggered by reflux”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: BTS/NICE/SIGN asthma guideline NG245: https://www.nice.org.uk/guidance/ng245/chapter/Recommendations