skip to main content

Difficult asthma — SCE Respiratory MCQ

Instant feedback + full explanation. One question, done properly.

HardAsthmaDifficult asthmaSCE Respiratory

A 61-year-old woman with difficult asthma has frequent attacks despite high-dose ICS/LABA, tiotropium and montelukast. BMI is 41 kg/m2, rhinitis is uncontrolled and pharmacy records show she collects preventer inhalers every 3 months. FeNO is 18 ppb and eosinophils are 0.09 x 10^9/L. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Address adherence, inhaler technique and comorbidities before labelling severe asthma

Difficult asthma should be distinguished from severe asthma by optimising adherence, technique and comorbidities before biologic or procedural escalation. Low FeNO, low eosinophils and poor prescription collection argue against immediate type 2 biologic therapy. Obesity and rhinitis are treatable traits that can mimic or worsen asthma control and should be actively managed.

Reference: BTS/NICE/SIGN Asthma Guideline NG245