American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the main treatment approach for patients with severe persistent asthma?

1. Inhaled short-acting beta agonist

2. Oral corticosteroids only

3. High dose inhaled steroids combined with long-acting beta agonists

4. Long-acting beta agonist only

The correct answer is: High dose inhaled steroids combined with long-acting beta agonists

The main treatment approach for patients with severe persistent asthma involves the use of high-dose inhaled corticosteroids combined with long-acting beta agonists. This combination therapy is crucial because it addresses the underlying inflammation associated with severe asthma while also providing long-term bronchodilation. Inhaled corticosteroids are the most effective anti-inflammatory medications for asthma management, improving symptoms, reducing the frequency of exacerbations, and enhancing overall lung function. For patients with severe persistent asthma, simply using inhaled corticosteroids at lower doses may not be sufficient to control their symptoms. Therefore, the high-dose formulation is essential in these cases to achieve better control of the disease. Long-acting beta agonists (LABAs) are added to enhance bronchodilation and improve respiratory function over an extended period. The combination of these two classes of medications not only helps in managing daily symptoms but also significantly decreases the possibility of asthma-related emergencies. On the other hand, inhaled short-acting beta agonists are typically reserved for quick relief of acute symptoms and do not address the chronic inflammation present in severe persistent asthma. Oral corticosteroids can be utilized in specific circumstances, often for acute exacerbations or temporary control, but are not the preferred long-term management strategy due to potential side effects with