skip to main content

Persistent asthma — RACGP Fellowship MCQ

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

HardChronic disease managementPersistent asthmaRACGP Fellowship

A 45-year-old woman has asthma symptoms most days and wakes twice weekly due to asthma. Spirometry shows an obstructive pattern with significant bronchodilator reversibility. She uses salbutamol daily and has required two oral prednisolone courses this year. Her inhaler technique is poor. What is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: B — Correct inhaler technique and commence inhaled corticosteroid-containing controller therapy

This patient has persistent asthma requiring controller therapy. The key discriminator is recognizing that poor inhaler technique is both the primary reason for apparent treatment failure AND the mandatory first step to address. Option B correctly identifies both: correcting technique and commencing ICS controller therapy. Option A fails because reversibility alone does not justify SABA monotherapy in persistent asthma—daily symptoms and exacerbations demand controller therapy. Option E is incorrect because oral prednisolone is for acute exacerbations, not maintenance, and carries systemic risks. Option D is incorrect—wheeze reflects airway inflammation/obstruction, not infection. Option C is incorrect and inappropriately diverts from necessary asthma management.

Reference: Self TH, et al. National and International Guidelines concur that inhaled corticosteroids are the preferred long-term maintenance drug therapy for persistent asthma. J Asthma. 2009 Dec;46(10):974–979. https://pubmed.ncbi.nlm.nih.gov/19995133/