American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary indication for initiating treatment upon a diagnosis of severe asthma?

1. Daily use of albuterol

2. Frequent hospitalizations

3. Medication non-adherence

4. Long-term oral corticosteroid use

The correct answer is: Frequent hospitalizations

The primary indication for initiating treatment upon a diagnosis of severe asthma is frequent hospitalizations. This is a significant marker that indicates poor asthma control and an increased risk of exacerbations, leading to the need for more aggressive management. When patients experience frequent hospitalizations due to asthma, it suggests that their current management strategies are inadequate, and they may be suffering from severe persistent asthma, which necessitates a step-up in therapy. This could include the introduction of long-acting bronchodilators, increased doses of inhaled corticosteroids, or other medications aimed at achieving better asthma control and preventing future hospitalizations. While daily use of albuterol can indicate poor control, it is more of a symptom of inadequate treatment rather than a primary reason to initiate treatment. Medication non-adherence also reflects a different issue related to patient behavior rather than the severity of the disease itself. Long-term oral corticosteroid use may be necessary for some patients with severe asthma, but it is generally considered a sign that more effective control measures should be implemented, rather than a direct indication to start treatment. Therefore, frequent hospitalizations stand out as the key factor that highlights the need for more aggressive treatment initiation in the case of severe asthma.