MRCP2-4347
A 45-year-old man presents to the respiratory outpatient clinic for review. He has a medical history of asthma, which was diagnosed during his childhood. As an adult, he has been admitted to the hospital multiple times due to asthma exacerbations, which tend to occur during the summer months. He reports experiencing a nocturnal cough up to three times per week, along with rhinorrhoea and dry eyes since the weather became warmer. He works in construction and finds that his symptoms worsen when he is outside. Three weeks ago, he was admitted to the hospital for an asthma exacerbation and was treated with salbutamol nebulisers and a short course of prednisolone. On examination, he has mild end expiratory wheeze in the upper posterior zones bilaterally. His vital signs are normal, and there is no pedal oedema.
The patient’s drug history includes salbutamol metered dose inhaler when required, salmeterol 50 micrograms/fluticasone propionate 500 micrograms – two puffs twice daily, and levetiracetam 500 mg twice daily. His laboratory results show an elevated IgE level of 500 UI/ml (normal range 150-300 UI/ml). Aspergillus precipitins are negative, and his chest x-ray is normal.
What is the most appropriate management for this patient?