Asthma Phenotypes and Management
GRAND ROUNDS REVIEW Asthma Phenotypes and Management: A Precision Medicine Approach for the Practising Clinician Dr Neeraj Manikath , claude.ai I. Clinical Introduction 🏥 Clinical Vignette The patient: A 34-year-old secondary school teacher presents to your respiratory clinic with a three-year history of recurrent breathlessness and wheeze. She has been on high-dose inhaled fluticasone-salmeterol for 18 months with minimal benefit. She has used her salbutamol inhaler up to eight times a day. She has had four courses of oral prednisolone in the past year. Blood tests reveal a peripheral eosinophil count of 680 cells/µL. Skin prick tests are negative. Her spirometry shows post-bronchodilator FEV1/FVC of 0.65 with 18% reversibility. Her FENO is 68 ppb. The junior registrar increases her ICS dose. You pause. You know this patient does not simply need more of the same — she needs a fundamental...