BCACP Pulmonary and Respiratory Disease Management

Question 1

A 34-year-old patient with moderate persistent asthma is currently on a low-dose inhaled corticosteroid (ICS) alone but continues to have symptoms 4 days per week.
According to GINA guidelines, what is the most appropriate step-up therapy?

Accepted Answer

Add a long-acting beta-agonist (LABA) to the existing low-dose ICS

Answer

Switch to a short-acting beta-agonist (SABA) as needed only

Answer

Add an oral leukotriene receptor antagonist and discontinue the ICS

Answer

Initiate systemic corticosteroids for 14 days

Question 2

A patient with COPD has an FEV1/FVC ratio of 0.62 and an FEV1 of 48% predicted. He reports two exacerbations in the past year requiring oral steroids. According to GOLD 2023, how is this patient classified?

Accepted Answer

GOLD Grade 2, Group E

Answer

GOLD Grade 2, Group B

Answer

GOLD Grade 3, Group E

Answer

GOLD Grade 3, Group B

Question 3

A patient with persistent asthma is prescribed a fluticasone/salmeterol dry powder inhaler. During medication counseling, which instruction is MOST important to emphasize regarding inhaler technique for a dry powder inhaler (DPI)?

Accepted Answer

Inhale forcefully and deeply through the mouthpiece to disperse the powder

Answer

Shake the inhaler vigorously for 5 seconds before each use

Answer

Exhale fully into the mouthpiece before actuation to prime the device

Answer

Hold the inhaler upright and press the canister while inhaling slowly

Question 4

Which of the following is the preferred initial maintenance therapy for a newly diagnosed COPD patient with an FEV1 of 65% predicted and no exacerbations in the past year (GOLD Grade 2, Group A)?

Accepted Answer

Long-acting muscarinic antagonist (LAMA) monotherapy

Answer

Inhaled corticosteroid (ICS) monotherapy

Answer

Short-acting bronchodilator as needed

Answer

Triple therapy: ICS + LABA + LAMA

Question 5

A patient presents to the ambulatory care clinic with an acute asthma exacerbation classified as moderate severity. Which pharmacological intervention is most appropriate to initiate FIRST?

Accepted Answer

Short-acting beta-agonist (SABA) via nebulizer or MDI with spacer

Answer

Inhaled ipratropium bromide alone

Answer

Intravenous magnesium sulfate

Answer

Systemic corticosteroids as the sole initial agent

Question 6

A pharmacist is reviewing therapy for a patient with COPD and newly diagnosed atrial fibrillation. The patient's current regimen includes a LABA/LAMA combination inhaler. Which monitoring concern should the pharmacist prioritize with LABAs in this patient?

Accepted Answer

Hypokalemia and QTc prolongation risk due to beta-agonist effects

Answer

Increased risk of osteoporosis from chronic beta-agonist use

Answer

Hepatotoxicity from LABA metabolism in the liver

Answer

Paradoxical bronchospasm that is unique to LABA/LAMA combinations