5th April 2024

You are working in a busy respiratory clinic. You see a 35-year-old insurance broker

You are working in a busy respiratory clinic. You see a 35-year-old insurance broker with a background of poorly controlled asthma. They mention to you that they have noticed their face has become more swollen over the last few months. They also report difficulty getting up from sitting recently.

They have had four admissions to hospital in the last twelve months due to asthma exacerbations. During one of these admissions, they developed urinary sepsis requiring ITU support. Their only other past medical history is adolescent acne, although the patient notes they have noticed this flaring up recently too.

What is the most likely underlying cause of the patient’s symptoms?

Select the SINGLE most appropriate option from the list below. Select ONE option only.