Asthma and COPD

23 Gulf Prometric Pharmacist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Asthma and COPD, part of Clinical Pharmacy and Therapeutics. The first 23 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Medium

   A 59-year-old man with asthma stable on theophylline is prescribed ciprofloxacin for a urinary infection. What is the concern?

   1. ACiprofloxacin will cause bronchoconstriction through beta-2 blockade
   2. BCiprofloxacin inhibits CYP1A2, raising theophylline levels and toxicity
   3. CNo interaction exists
   4. DCiprofloxacin induces CYP1A2, lowering theophylline levels and its effect

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   Answer: B · Ciprofloxacin inhibits CYP1A2, raising theophylline levels and toxicity

   Theophylline is metabolised by CYP1A2, which ciprofloxacin inhibits, so levels can rise to the toxic range with nausea, tachyarrhythmia and seizures. Monitoring levels and reducing the dose by about a third, or choosing another antibiotic, avoids harm.

   • A: Ciprofloxacin has no beta-blocking action.
   • C: The interaction is well documented.
   • D: Inhibition raises, not lowers, levels.

   Remember this

   Ciprofloxacin and macrolides raise theophylline levels.

2. Question 2 · Easy

   A patient using a beclometasone inhaler develops a sore, white-coated mouth. What counselling would have reduced the risk?

   1. ARinse the mouth with water and spit after each dose
   2. BUse the inhaler only at night
   3. CInhale more slowly
   4. DSwallow a glass of milk after use

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   Answer: A · Rinse the mouth with water and spit after each dose

   Inhaled corticosteroid deposited in the oropharynx suppresses local immunity and causes oral candidiasis and hoarseness. Rinsing and spitting after each dose removes the drug, and a spacer with a pressurised inhaler cuts deposition further.

   • B: Timing of the dose does not remove deposited drug.
   • C: Inhalation speed does not prevent oropharyngeal deposition.
   • D: Milk does not clear the mouth reliably.

   Remember this

   Rinse and spit after inhaled corticosteroids to prevent oral thrush.

3. Question 3 · Medium

   A pregnant woman with asthma is worried about inhaled budesonide and wants to stop it. What is the most appropriate advice?

   1. AStop it until the second trimester, then restart at a lower dose carefully if symptoms return
   2. BContinue it, as uncontrolled asthma is riskier for the baby than inhaled budesonide
   3. CSwitch to regular oral prednisolone
   4. DUse salbutamol alone

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   Answer: B · Continue it, as uncontrolled asthma is riskier for the baby than inhaled budesonide

   Poorly controlled asthma raises the risk of preterm birth, low birth weight and pre-eclampsia, and budesonide has the most reassuring pregnancy data among inhaled corticosteroids. Stopping it removes control of airway inflammation. Oral steroids carry greater fetal risk.

   • A: Stopping controller therapy risks exacerbations.
   • C: Regular oral steroids add risk compared with inhaled therapy.
   • D: Salbutamol alone leaves inflammation untreated.

   Remember this

   Continue inhaled corticosteroids in pregnancy because uncontrolled asthma is riskier.

4. Question 4 · Medium

   A 31-year-old woman in the emergency department has an acute asthma exacerbation. Besides oxygen and a short-acting bronchodilator, which systemic therapy should start within the first hour?

   1. AIntravenous antibiotics routinely
   2. BOral montelukast alone
   3. COral prednisolone 40 to 50 mg daily for 5 to 7 days
   4. DIntravenous aminophylline as the first-line systemic treatment

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   Answer: C · Oral prednisolone 40 to 50 mg daily for 5 to 7 days

   Systemic corticosteroids speed recovery and reduce relapse when given early, and oral prednisolone 40 to 50 mg for 5 to 7 days is as effective as intravenous dosing. Antibiotics are not routinely required since most exacerbations are viral, and aminophylline adds toxicity without benefit over standard treatment.

   • A: Routine antibiotics are not indicated for most exacerbations.
   • B: Montelukast alone does not treat a severe exacerbation.
   • D: Aminophylline has a narrow margin and little added benefit.

   Remember this

   Give oral prednisolone 40 to 50 mg early in an asthma exacerbation.

5. Question 5 · Hard

   A 68-year-old man with COPD is on LABA-LAMA-ICS and has had pneumonia. He has had no exacerbation in 2 years, and his blood eosinophil count is 40 cells/microlitre. What is the most appropriate step?

   1. ADe-escalate by withdrawing the ICS and continue LABA-LAMA
   2. BIncrease the ICS dose to improve control further
   3. CContinue triple therapy unchanged and review in a year
   4. DAdd long-term azithromycin to reduce exacerbations further

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   Answer: A · De-escalate by withdrawing the ICS and continue LABA-LAMA

   A low eosinophil count predicts little benefit from ICS, and the patient has had a serious ICS-associated adverse event, pneumonia, with no recent exacerbation. GOLD supports stopping the ICS, usually with little loss of control. Increasing the ICS adds risk, and azithromycin is for frequent exacerbators.

   • B: A higher dose would add risk without benefit.
   • C: Continuing exposes him to continuing pneumonia risk for little gain.
   • D: Azithromycin is for ongoing exacerbations, not for this patient.

   Remember this

   Withdraw the ICS when eosinophils are low, pneumonia occurs and exacerbations are absent.

6. Question 6 · Medium

   A patient with asthma and hypertension needs an antihypertensive. Which agent is most likely to provoke bronchospasm and should be avoided?

   1. APropranolol
   2. BLosartan
   3. CAmlodipine
   4. DIndapamide

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   For a hospitalised patient with a COPD exacerbation who also needs systemic corticosteroid, what duration does GOLD recommend?

   1. APrednisolone 40 mg daily for 21 days
   2. BPrednisolone 40 mg daily for 5 days
   3. CA 3-month tapering course
   4. DA single intravenous dose only

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8. Question 8 · Easy

   What is the main benefit of adding a spacer to a pressurised metered-dose inhaler?

   1. AIt makes the drug act longer
   2. BIt reduces oropharyngeal deposition and the need for hand-breath coordination
   3. CIt increases the amount of drug delivered to the lungs by roughly 10 times per puff
   4. DIt prevents the inhaler from needing priming

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9. Question 9 · Easy

   How does tiotropium produce bronchodilation in COPD?

   1. AIt stimulates beta-2 receptors
   2. BIt inhibits phosphodiesterase-4
   3. CIt blocks muscarinic M3 receptors in airway smooth muscle
   4. DIt antagonises cysteinyl leukotriene receptors on airway smooth muscle

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10. Question 10 · Medium

    A 24-year-old man has asthma symptoms about 3 times a month, with no night waking, and uses salbutamol alone. According to GINA, what is the best treatment?

    1. ADaily oral theophylline
    2. BSalbutamol alone, taken as needed
    3. CDaily high-dose ICS
    4. DAs-needed low-dose ICS-formoterol

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11. Question 11 · Easy

    Which reliever inhaler does GINA now prefer for adults and adolescents with asthma, rather than salbutamol alone?

    1. ASalbutamol alone, taken as needed whenever symptoms occur between exacerbations
    2. BOral montelukast, taken as needed
    3. CIpratropium, taken as needed
    4. DLow-dose inhaled corticosteroid with formoterol, taken as needed

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12. Question 12 · Medium

    A parent reports that their 10-year-old, who takes montelukast for asthma, has developed nightmares and low mood. What is the most appropriate pharmacist action?

    1. ADouble the montelukast dose at night to improve control of the child's asthma
    2. BSwitch to a different leukotriene drug at the same dose
    3. CReassure that montelukast has no mental health effects
    4. DRefer for review, as montelukast carries a neuropsychiatric warning

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13. Question 13 · Medium

    A 66-year-old man with COPD had two moderate exacerbations last year, despite a LABA-LAMA combination. His blood eosinophil count is 350 cells/microlitre. What is the best escalation according to GOLD?

    1. AAdd a long-term oral prednisolone
    2. BStop the LAMA and use ICS alone
    3. CSwitch to LABA-LAMA-ICS triple therapy
    4. DAdd oral theophylline only

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14. Question 14 · Medium

    A patient with COPD on a fluticasone-containing inhaler for 3 years is admitted with pneumonia. Which statement about this risk is correct?

    1. AThe risk applies only to oral steroids
    2. BInhaled corticosteroids increase the risk of pneumonia in COPD
    3. CPneumonia risk is related to LAMAs only
    4. DInhaled corticosteroids protect against pneumonia by reducing airway inflammation

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15. Question 15 · Hard

    During a severe asthma attack, a pMDI delivers 100 micrograms of salbutamol per actuation. A patient takes 4 puffs through a spacer every 20 minutes for the first hour. What is the total dose delivered in that hour?

    1. A1,200 micrograms
    2. B400 micrograms
    3. C800 micrograms
    4. D2,400 micrograms

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16. Question 16 · Medium

    A 29-year-old woman with asthma is uncontrolled on a low-dose ICS-LABA as maintenance with as-needed salbutamol, using the reliever 4 times a week. Following the GINA step 3 track 1 approach, which change is preferred?

    1. ALow-dose budesonide-formoterol as both maintenance and reliever
    2. BSwitch to oral prednisolone daily
    3. CDouble the ICS dose and keep salbutamol
    4. DAdd oral montelukast 10 mg daily and keep the same inhalers unchanged

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17. Question 17 · Medium

    A 70-year-old man with COPD has mild symptoms and no exacerbations in the past year (GOLD group A). Which initial therapy is recommended?

    1. ALong-term oral corticosteroids
    2. BRoflumilast 500 microgram once daily as add-on
    3. CA bronchodilator, short- or long-acting
    4. DLABA-LAMA-ICS triple therapy

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18. Question 18 · Hard

    A 40-year-old woman has severe asthma with frequent exacerbations despite high-dose ICS-LABA and a LAMA. Blood eosinophils are 450 cells/microlitre on repeat testing. Which add-on is best matched to her phenotype?

    1. AOmalizumab (anti-IgE) regardless of allergy
    2. BMepolizumab (anti-IL-5)
    3. CLong-term oral montelukast alone
    4. DRoflumilast

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19. Question 19 · Easy

    Which inhalation technique is needed for a dry powder inhaler?

    1. AShaking the device before each use
    2. BA rapid, forceful and deep inhalation
    3. CA slow, gentle inhalation
    4. DExhaling into the device first

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20. Question 20 · Medium

    A patient in a COPD exacerbation is on supplemental oxygen. What is the target oxygen saturation?

    1. A94 to 98%
    2. B88 to 92%
    3. C80 to 85%
    4. DAbove 99%

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21. Question 21 · Hard

    A 62-year-old woman with COPD is given repeated salbutamol nebulisers while also taking furosemide. Which monitoring is most important?

    1. ASerum potassium
    2. BSerum calcium
    3. CSerum urate
    4. DSerum sodium only

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22. Question 22 · Hard

    A 55-year-old man stabilised on theophylline stops smoking 2 weeks ago. His dose has not changed. What is the likely consequence?

    1. ALevels stay the same
    2. BTheophylline levels rise because CYP1A2 induction is lost
    3. CTheophylline levels fall
    4. DTheophylline is excreted unchanged so smoking is irrelevant

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23. Question 23 · Medium

    A patient using a pressurised metered-dose inhaler without a spacer inhales quickly and the dose hits the back of the throat. What is the best technique advice?

    1. ABreathe in gently once the puff has been released and the aerosol has formed a cloud in the mouth
    2. BBreathe in slowly and deeply as you press the canister, then hold for about 10 seconds
    3. CPress the canister twice before breathing in
    4. DBreathe in as fast as possible

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