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Severe eosinophilic asthma — SCE Respiratory MCQ

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HardAsthmaSevere eosinophilic asthmaSCE Respiratory

A 52-year-old man has severe asthma despite high-dose inhaled corticosteroid/formoterol, tiotropium and good adherence. He has had four oral steroid bursts in 12 months. Blood eosinophils are 0.78 x 10^9/L, FeNO is 72 ppb and total IgE is normal with no perennial allergen sensitisation. What is the most appropriate management?

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Correct answer: B — Refer for anti-IL-5 biologic assessment

This is uncontrolled severe eosinophilic asthma and referral for biologic assessment such as anti-IL-5 treatment is the best next step. Omalizumab is targeted to allergic IgE-mediated asthma and is less appropriate without sensitisation. Macrolides and bronchial thermoplasty may have roles in selected patients, but type 2 biomarker-driven biologic assessment should precede maintenance oral steroid escalation.

Reference: BTS/NICE/SIGN Asthma Pathway 2024; ERS/ATS Severe Asthma Guideline