Adult asthma — structured viva

Structured oral on adult asthma: defending the anti-inflammatory reliever paradigm with trial evidence, interpreting diagnostic test performance, stewarding oral corticosteroids, and handling the biomarker-versus-symptoms question examiners love.

Prompt

The examiner opens: 'A colleague tells you their asthma patients are fine on a salbutamol puffer alone — why do you keep saying that has to change?' The viva then branches through the trial evidence, diagnostic uncertainty, escalation and biologics, oral corticosteroid stewardship, and the special populations.

Stem

You are the GP. A practice colleague says their asthma patients 'do fine' on a salbutamol inhaler alone. ^[1]

References10Show

[1]Reddel HK, Bacharier LB, Bateman ED, et al. Global Initiative for Asthma Strategy 2021. Executive Summary and Rationale for Key Changes Archivos de bronconeumologia, 2022.PMID 35245179
[2]Levy ML, Bacharier LB, Bateman E, et al. Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update NPJ primary care respiratory medicine, 2023.PMID 36754956
[3]Beasley R, Holliday M, Reddel HK, et al. Controlled Trial of Budesonide-Formoterol as Needed for Mild Asthma The New England journal of medicine, 2019.PMID 31112386
[4]LaForce C, Albers F, Danilewicz A, et al. As-Needed Albuterol-Budesonide in Mild Asthma The New England journal of medicine, 2025.PMID 40388330
[5]Noble JH, Bean O, Perry M, et al. Budesonide-formoterol versus terbutaline reliever in adults with asthma using maintenance inhaled corticosteroids in New Zealand (INFORM ASTHMA): an open-label, parallel-group, randomised, controlled, phase 4 trial The Lancet. Respiratory medicine, 2026.PMID 41520676
[6]Simpson AJ, Drake S, Healy L, et al. Asthma diagnosis: a comparison of established diagnostic guidelines in adults with respiratory symptoms EClinicalMedicine, 2024.PMID 39296585
[7]Chandrasekara S, Wark P Biologic therapies for severe asthma with persistent type 2 inflammation Australian prescriber, 2024.PMID 38737370
[8]Blakey J, Chung LP, McDonald VM, et al. Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand Respirology (Carlton, Vic.), 2021.PMID 34587348
[9]Couillard S, Meulmeester FL, Charland P, et al. Symptom burden to characterise, predict, and prevent asthma attacks: a patient-level meta-analysis of randomised trials and translational prospective studies The Lancet. Respiratory medicine, 2026.PMID 42624803
[10]Reddel HK, Ampon MR, Poulos LM, et al. Worsening Asthma Outcomes in Australian Adults: A Comparison of Stratified Sample Surveys in 2012 and 2021 The Medical journal of Australia, 2026.PMID 42338170

Adult asthma — structured viva

Stem

You are the GP. A practice colleague says their asthma patients 'do fine' on a salbutamol inhaler alone. ^[1]

References10Show

[1]Reddel HK, Bacharier LB, Bateman ED, et al. Global Initiative for Asthma Strategy 2021. Executive Summary and Rationale for Key Changes Archivos de bronconeumologia, 2022.PMID 35245179
[2]Levy ML, Bacharier LB, Bateman E, et al. Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update NPJ primary care respiratory medicine, 2023.PMID 36754956
[3]Beasley R, Holliday M, Reddel HK, et al. Controlled Trial of Budesonide-Formoterol as Needed for Mild Asthma The New England journal of medicine, 2019.PMID 31112386
[4]LaForce C, Albers F, Danilewicz A, et al. As-Needed Albuterol-Budesonide in Mild Asthma The New England journal of medicine, 2025.PMID 40388330
[5]Noble JH, Bean O, Perry M, et al. Budesonide-formoterol versus terbutaline reliever in adults with asthma using maintenance inhaled corticosteroids in New Zealand (INFORM ASTHMA): an open-label, parallel-group, randomised, controlled, phase 4 trial The Lancet. Respiratory medicine, 2026.PMID 41520676
[6]Simpson AJ, Drake S, Healy L, et al. Asthma diagnosis: a comparison of established diagnostic guidelines in adults with respiratory symptoms EClinicalMedicine, 2024.PMID 39296585
[7]Chandrasekara S, Wark P Biologic therapies for severe asthma with persistent type 2 inflammation Australian prescriber, 2024.PMID 38737370
[8]Blakey J, Chung LP, McDonald VM, et al. Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand Respirology (Carlton, Vic.), 2021.PMID 34587348
[9]Couillard S, Meulmeester FL, Charland P, et al. Symptom burden to characterise, predict, and prevent asthma attacks: a patient-level meta-analysis of randomised trials and translational prospective studies The Lancet. Respiratory medicine, 2026.PMID 42624803
[10]Reddel HK, Ampon MR, Poulos LM, et al. Worsening Asthma Outcomes in Australian Adults: A Comparison of Stratified Sample Surveys in 2012 and 2021 The Medical journal of Australia, 2026.PMID 42338170