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Severe eosinophilic asthma — SCE Respiratory MCQ

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HardAsthmaSevere eosinophilic asthmaSCE Respiratory

A 51-year-old woman remains symptomatic despite high-dose ICS/formoterol MART, tiotropium and confirmed adherence. She has had four prednisolone-treated exacerbations in the past year. Blood eosinophils are 0.82 x 10^9/L, FeNO is 72 ppb, total IgE is normal and skin prick tests are negative. What is the most likely diagnosis?

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Correct answer: A — Severe eosinophilic asthma

The recurrent exacerbations despite optimised high-dose inhaled therapy, high FeNO and marked eosinophilia indicate severe eosinophilic asthma. Omalizumab-type allergic asthma is less likely because IgE and skin prick testing are not supportive, and vocal cord dysfunction would not explain the type 2 inflammatory markers. ABPA would need Aspergillus sensitisation or central bronchiectasis, while COPD is not the best fit in this phenotype.

Reference: BTS/NICE/SIGN Asthma Guideline NG245; NICE severe asthma technology appraisals