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Difficult severe asthma — SCE Respiratory MCQ

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HardAsthmaDifficult severe asthmaSCE Respiratory

A 57-year-old woman with severe asthma is being considered for biologic therapy. She has daily symptoms, three attacks requiring prednisolone in a year and persistent nasal polyposis. Eosinophils are 1.1 x 10^9/L and FeNO is 86 ppb despite high-dose ICS/formoterol and tiotropium. What is the most appropriate investigation before selection of biologic treatment?

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Correct answer: B — Structured severe-asthma phenotyping

Before biologics, severe asthma assessment should confirm the diagnosis, adherence, inhaler technique, comorbidities and inflammatory phenotype. This prevents inappropriate biologic use in uncontrolled but modifiable difficult asthma. Bronchoscopy, PET-CT and pleural aspiration are not routine steps in phenotyping severe eosinophilic asthma.

Reference: ERS/ATS Severe Asthma Guideline; BTS/NICE/SIGN Asthma Pathway 2024: https://www.nice.org.uk/guidance/ng245/chapter/recommendations