Question 1

The first-line therapy for mild-persistent asthma is:&#10;A) High-dose montelukast&#10;B) Theophylline&#10;C) Low-dose inhaled corticosteroids&#10;D) Long-acting beta-2-agonists&#10;

Accepted Answer

Low-dose inhaled corticosteroids are considered the first-line therapy for mild-persistent asthma as they have been shown to reduce symptoms, improve lung function, and decrease exacerbations with minimal side effects. Montelukast and theophylline may be used as adjunctive therapies or as alternatives if inhaled corticosteroids are not tolerated, but they are not considered first-line options. Long-acting beta-2-agonists may be used in combination with inhaled corticosteroids for moderate to severe asthma, but they are not recommended as monotherapy for mild-persistent asthma.

Question 2

One goal of asthma management in children is:&#10;A) They independently manage their asthma&#10;B) Participation in school and sports activities&#10;C) No exacerbations&#10;D) Minimal use of inhaled corticosteroids&#10;

Accepted Answer

The goal of asthma management in children is for them to be able to participate fully in school and sports activities without limitations or symptoms. While independence in asthma management is also a goal, it is not the primary focus. Avoiding exacerbations is another key goal, but it is not the only one. The use of inhaled corticosteroids may be necessary for effective management, so minimizing their use is not necessarily a priority goal.

Question 3

One goal of asthma therapy outlined by the NHLBI Expert Panel 3 guidelines is:&#10;A) Ability to use albuterol daily to control symptoms&#10;B) Minimize exacerbations to once a month&#10;C) Keep nighttime symptoms at a maximum of twice a week&#10;D) Require infrequent use of beta 2 agonists (albuterol) for relief of symptoms&#10;

Accepted Answer

According to the NHLBI Expert Panel 3 guidelines, one of the goals of asthma therapy is to require infrequent use of beta 2 agonists (such as albuterol) for relief of symptoms. This indicates that overall asthma control should be achieved with other forms of treatment, such as controller medications, and that rescue inhaler use should be minimized. Choices A, B, and C do not accurately reflect this goal as they all involve some level of ongoing symptom management or exacerbation frequency.

Question 4

Monitoring a patient with persistent asthma includes:&#10;A) Monitoring how frequently the patient has an upper respiratory infection (URI) during treatment&#10;B) Monthly in-office spirometry testing&#10;C) Determining if the patient has increased use of his or her long-acting beta-2-agonist due to exacerbations&#10;D) Evaluating the patient every 1 to 6 months to determine if the patient needs to step up or down in their therapy&#10;

Accepted Answer

Evaluating the patient every 1 to 6 months is recommended to assess asthma control and adjust therapy as needed, according to asthma management guidelines.

Question 5

In children age 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms occur:&#10;A) At nighttime one to two times a month&#10;B) At nighttime three to four times a month&#10;C) Less than twice a week&#10;D) Daily&#10;

Accepted Answer

Mild-persistent asthma in children aged 5 to 11 years is diagnosed when asthma symptoms occur at nighttime three to four times a month.

Question 6

Prior to developing a plan for the treatment of asthma, the patient's asthma should be classified according to the NHLBI Expert Panel 3 guidelines. In adults mild-persistent asthma is classified as asthma symptoms that occur:

A) Daily
B) Daily and limit physical activity
C) Less than twice a week
D) More than twice a week and less than once a day

Accepted Answer

Mild-persistent asthma in adults is classified as having symptoms more than twice a week but less than once a day, according to the NHLBI Expert Panel 3 guidelines.

Question 7

A stepwise approach to the pharmacologic management of asthma:&#10;A) Begins with determining the severity of asthma and assessing asthma control&#10;B) Is used when asthma is severe and requires daily steroids&#10;C) Allows for each provider to determine their personal approach to the care of asthmatic patients&#10;D) Provides a framework for the management of severe asthmatics, but is not as helpful when patients have intermittent asthma&#10;

Accepted Answer

Beginning with determining the severity of asthma and assessing asthma control is the recommended approach to pharmacologic management of asthma as it allows for appropriate treatment decisions to be made based on the individual patient's level of asthma control.

Answer: D 
 While a stepwise approach can be helpful in the management of severe asthmatics, it may not be as helpful when patients have intermittent asthma. For patients with intermittent asthma, treatment may be more focused on as-needed bronchodilator therapy rather than a stepwise approach.

(Note: Choices B and C are not accurate as they do not reflect the recommended approach to the pharmacologic management of asthma.)

Question 8

Treatment for mild intermittent asthma is:&#10;A) Daily inhaled medium-dose corticosteroids&#10;B) Short-acting beta-2-agonists (albuterol) as needed&#10;C) Long-acting beta-2-agonists every morning as a preventative&#10;D) Montelukast (Singulair) daily&#10;

Accepted Answer

Mild intermittent asthma is characterized by symptoms occurring less than two days a week and nighttime symptoms less than twice a month. The primary treatment for mild intermittent asthma is short-acting beta-2-agonists (such as albuterol) as needed for symptom relief. Daily inhaled medium-dose corticosteroids or long-acting beta-2-agonists are not necessary for this level of asthma severity. Montelukast can be used as an alternative or add-on therapy in some cases, but is not the primary treatment for mild intermittent asthma.

Question 9

Patients with COPD require monitoring of:&#10;A) Beta-2-agonist use&#10;B) Serum electrolytes&#10;C) Blood pressure&#10;D) Neuropsychiatric effects of montelukast&#10;

Accepted Answer

The answer of Patients with COPD require monitoring of:&#10;A) Beta-2-agonist...

Question 10

Education for patients who use an inhaled beta-agonist and an inhaled corticosteroid includes:&#10;A) Use the inhaled corticosteroid first, followed by the inhaled beta-agonists.&#10;B) Use the inhaled beta-agonist first, followed by the inhaled corticosteroid.&#10;C) Increase fluid intake to 3 liters per day.&#10;D) Avoid use of aspirin or ibuprofen while using inhaled medications.&#10;

Accepted Answer

Patients should use their inhaled beta-agonist first to open up the airways, followed by the inhaled corticosteroid to reduce inflammation. This is known as the "reliever-first" strategy and has been found to be more effective in controlling asthma symptoms. Increasing fluid intake and avoiding aspirin or ibuprofen are not directly related to the use of inhaled medications.

Question 11

Asthma exacerbations at home are managed by the patient by:&#10;A) Increasing frequency of beta-2-agonists and contacting their provider&#10;B) Doubling inhaled corticosteroid doses&#10;C) Increasing frequency of beta-2-agonists&#10;D) Starting montelukast (Singulair)&#10;

Accepted Answer

The answer of Asthma exacerbations at home are managed by...

Question 12

Pregnant patients with asthma may safely use ________ throughout their pregnancy.&#10;A) Oral terbutaline&#10;B) Prednisone&#10;C) Inhaled corticosteroids (budesonide)&#10;D) Montelukast (Singulair)&#10;

Accepted Answer

The answer of Pregnant patients with asthma may safely use...

Question 13

Medications used in the management of patients with chronic obstructive pulmonary disease (COPD) include:&#10;A) Inhaled beta-2-agonists&#10;B) Inhaled anticholinergics (ipratropium)&#10;C) Inhaled corticosteroids&#10;D) All of the above&#10;

Accepted Answer

The answer of Medications used in the management of patients...

Question 14

Patients with a COPD exacerbation may require:&#10;A) Doubling of inhaled corticosteroid dose&#10;B) Systemic corticosteroid burst&#10;C) Continuous inhaled beta-2-agonists&#10;D) Leukotriene therapy&#10;

Accepted Answer

The answer of Patients with a COPD exacerbation may require:&#10;A)...

Question 15

Education of patients with COPD who use inhaled corticosteroids includes:&#10;A) Doubling the dose at the first sign of a URI&#10;B) Using their inhaled corticosteroid first and then their bronchodilator&#10;C) Rinsing their mouth after use&#10;D) Abstaining from smoking for at least 30 minutes after using&#10;

Accepted Answer

The answer of Education of patients with COPD who use...

Question 16

Patients who are at risk of a fatal asthma attack include patients:&#10;A) With moderate persistent asthma&#10;B) With a history of requiring intubation or ICU admission for asthma&#10;C) Who are on daily inhaled corticosteroid therapy&#10;D) Who are pregnant&#10;

Accepted Answer

The answer of Patients who are at risk of a...

Deck 30: Asthma and Chronic Obstructive Pulmonary Disease