American Board of Internal Medicine (ABIM) Certification Practice Exam

Which medication can help reduce asthma exacerbations in patients with severe persistent asthma and high eosinophil counts?

1. Roflumilast

2. Montelukast

3. Benralizumab

4. Budesonide

The correct answer is: Benralizumab

Benralizumab is an appropriate medication for patients with severe persistent asthma who have high eosinophil counts. This drug is a monoclonal antibody that specifically targets the IL-5 receptor on eosinophils, leading to their depletion. High eosinophil levels in asthma are associated with more severe disease and a higher frequency of exacerbations. By reducing eosinophilic inflammation, Benralizumab can help to decrease the incidence of asthma exacerbations and improve overall asthma control in these patients. In contrast, other options like Roflumilast have a primary indication for chronic obstructive pulmonary disease (COPD) and are not first-line treatments for asthma. Montelukast is a leukotriene receptor antagonist that provides some benefit in asthma management but is generally less effective in those with severe eosinophilic asthma. Budesonide, a corticosteroid, is effective for managing asthma but may not be as tailored to reducing exacerbations specifically tied to eosinophilic activity as Benralizumab.