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Poorly controlled severe asthma — SCE Respiratory MCQ

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HardVaccinationPoorly controlled severe asthmaSCE Respiratory

On 18 August 2026, an English respiratory service is planning vaccination after the forthcoming expansion of the NHS respiratory syncytial virus (RSV) programme on 1 September 2026. A 68-year-old man has severe eosinophilic asthma treated with benralizumab. During the preceding 24 months, he has required two courses of oral prednisolone but no hospital admission. He is currently clinically stable. Twelve years ago, he developed Guillain–Barré syndrome following Campylobacter enteritis and made a complete recovery. He has never received an RSV vaccine and has no history of vaccine anaphylaxis. He is due autumn COVID-19 and influenza vaccination and is reliable about attending separate appointments. Which vaccination plan is most appropriate under the national programme?

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Correct answer: D — Give Abrysvo with COVID-19 vaccine and give influenza vaccine on a separate day, with no minimum interval

From 1 September 2026, the English NHS programme includes adults aged 65–74 years with chronic respiratory disease, including poorly controlled asthma. The Green Book definition is met by at least two courses of oral corticosteroids in the preceding 24 months; current stability does not remove eligibility. The programme uses a single dose of Abrysvo. Abrysvo can be co-administered with a COVID-19 vaccine. In older adults, however, RSV vaccine should not routinely be scheduled on the same day as influenza vaccine because co-administration may diminish immune responses to RSV and the influenza A(H3N2) component. No specific interval is required, so influenza can be given at a separate visit without an arbitrary delay. Previous Guillain–Barré syndrome is not itself a contraindication. A is reserved for circumstances such as likely non-attendance or a need for immediate protection, neither of which applies. B reflects the former age-based programme and overlooks the new clinical-risk cohort. C incorrectly treats remote Guillain–Barré syndrome as a contraindication; confirmed anaphylaxis to an RSV vaccine or its excipients would be relevant. E uses a licensed RSV vaccine, but not the product selected for the national programme, which is Abrysvo.

Reference: Respiratory syncytial virus: the Green Book chapter (3 June 2026) — https://assets.publishing.service.gov.uk/media/6a2015a4730aece621f09866/Green_Book_RSV_20260603.pdf Annexe A: detailed information, guidance and resources for healthcare professionals (1 July 2026) — https://www.gov.uk/government/publications/rsv-vaccination-expansion-of-eligibility-to-older-adults-in-certain-clinical-risk-groups/annexe-adetailed-information-guidance-and-resources-for-healthcare-professionals Respiratory syncytial virus (RSV) vaccine: VGD template (29 July 2026) — https://www.gov.uk/government/publications/respiratory-syncytial-virus-rsv-vaccine-vgd-template