Phys Vivas · respiratory
Asthma and Severe Asthma — Viva Defence
Structured DCE viva for severe asthma: long-case defence covering phenotyping, biologic selection, oral-steroid-sparing strategy, comorbidity integration, and acute severe asthma escalation, plus short-case respiratory examination discussion.
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Asthma and Severe Asthma — Viva
The scenario
A 49-year-old female veterinary nurse is referred to your severe asthma service. She has asthma since childhood, now with four to six exacerbations per year, two hospital admissions in the last 18 months (one to ICU), and daily symptoms despite high-dose budesonide-formoterol (MART), tiotropium, and maintenance prednisolone 10 mg daily. She has chronic rhinosinusitis with nasal polyps (two prior surgeries), allergic rhinitis, BMI 34, osteoporosis (T-score -2.9), and hypertension. Never-smoker. Bloods: eosinophils 520/microL, total IgE 310 IU/mL, FeNO 65 ppb. Spirometry: FEV1 64% predicted, fully reversible. Pharmacy data confirms adherence; technique is good on observation. [1]
References6ShowHide
- [1]Beasley R, Holliday M, Reddel HK, et al. Controlled Trial of Budesonide-Formoterol as Needed for Mild Asthma N Engl J Med, 2019.PMID 31112386
- [2]Castro M, Corren J, Pavord ID, et al. Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma N Engl J Med, 2018.PMID 29782217
- [3]Rabe KF, Nair P, Brusselle G, et al. Efficacy and Safety of Dupilumab in Glucocorticoid-Dependent Severe Asthma N Engl J Med, 2018.PMID 29782224
- [4]Ortega HG, Liu MC, Pavord ID, et al. Mepolizumab treatment in patients with severe eosinophilic asthma N Engl J Med, 2014.PMID 25199059
- [5]Kew KM, Kirtchuk L, Michell CI Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department Cochrane Database Syst Rev, 2014.PMID 24865567
- [6]Kerstjens HA, Engel M, Dahl R, et al. Tiotropium in asthma poorly controlled with standard combination therapy N Engl J Med, 2012.PMID 22938706