1. A 52-year-old Caucasian woman presents 5 days after an acute asthma exacerbation that led her to present to a local emergency department. She explains that her asthma was diagnosed 10 years earlier and had been well controlled with inhaled corticosteroid (ICS) therapy until about 3 years ago, when she began experiencing exacerbations roughly twice a year. She also reports experiencing intermittent, low-grade fevers over the past few months and a 3.2-kg weight gain in the past year without changing her dietary habits or level of physical activity.
Noteworthy findings from the laboratory evaluations and imaging studies ordered by the emergency department physician include the following
  • Peripheral blood eosinophil count: 732/mcL
  • Antineutrophil cytoplasmic antibodies (ANCA) status: negative
  • Chest radiograph: ground-glass opacities in the lungs, with a bilateral symmetrical distribution<
2. After a thorough evaluation, you diagnose the patient with EGPA.
3. The patient returns for a follow-up visit 12 months after your diagnosis of EGPA. She has been doing well on ICS, 10 mg per day, with no indication of disease progression at prior quarterly visits or at this visit. However, each time you have attempted to lower the dose of her ICS over the past year, she has reported worsening asthma symptoms. At this visit, you consider introducing another agent to her treatment regimen, and you weigh the evidence for the various therapeutic classes employed in managing EGPA.
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