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CHEST Curriculum Pathway for Asthma: Sample Content

This sample content offers a glimpse of content found in the comprehensive CHEST Curriculum Pathway for Asthma. Deepen your knowledge with the best of CHEST asthma resources, including CHEST SEEK® questions, annual meeting and board review videos, and journal articles, all in one easy-to-access destination.

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PRETEST

Which of the following patients is the most appropriate candidate for the treatment of mepolizumab?

  1. A 34-year-old man with asthma, not responding to high-dose inhaled corticosteroids/long-acting β-agonist. His eosinophil count is 403/µL (0.40 × 109/L), and he has a history of three exacerbations in the past 12 months.
  2. A 64-year-old woman with COPD with a history of hospital admission and two exacerbations that required prednisone in the past 12 months. Her eosinophil count is 448/µL (0.45 × 109/L). 
  3. A 28-year-old woman with asthma and allergic rhinitis controlled by medium-dose inhaled corticosteroids/long-acting β-agonist and montelukast. Her eosinophil count is 566/µL (0.57 × 109/L). 
  4. A 37-year-old man with asthma with a history of four exacerbations in the past 12 months, including an ICU admission. Current therapy includes high-dose inhaled corticosteroids/long-acting β-agonist and an inhaled long-acting muscarinic antagonist. His eosinophil count is 110/µL (0.11 × 109/L). 

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A. A 34-year-old man with asthma, not responding to high-dose inhaled corticosteroids/long-acting β-agonist. His eosinophil count is 403/µL (0.40 × 109/L), and he has a history of three exacerbations in the past 12 months.

Mepolizumab and reslizumab are monoclonal antibodies that target IL-5. Benralizumab targets the alpha subunit of the IL-5 receptor. Dupilumab targets the alpha subunit of the IL-4 receptor. These four biologics are approved for patients with eosinophilic asthma that is not controlled despite inhaled corticosteroids and a second controller. These medications are indicated for patients with frequent exacerbations (choice A is correct).

Mepolizumab is not approved for asthma that is adequately controlled with inhaled therapies (choice C is incorrect).

The eosinophilic phenotype has been defined based on the response to therapy; in mepolizumab, the eosinophilic phenotype is a blood eosinophil count higher than 150/µL (0.15 × 109/L) (choice D is incorrect). 

Mepolizumab has not been shown to be effective in patients with milder disease and eosinophilia or in patients who lack the eosinophilic phenotype. Mepolizumab is currently not approved for COPD (choice B is incorrect). 

Brusselle GG, Koppelman GH. Biologic therapies for severe asthma. N Engl J Med. 2022;386(2):157-171. 

Ortega HG, Liu MC, Pavord ID, et al; MENSA Investigators. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med. 2014;371(13):1198-1207. 

Global Initiative for Asthma. Accessed November 28, 2022. https://ginasthma.org/