MTM Respiratory Disease Management 2

Question 1

A patient's asthma is uncontrolled despite adherence to Step 3 therapy (low-dose ICS/LABA). Per GINA guidelines, what is the appropriate next step?

Accepted Answer

Step up to medium-dose ICS/LABA

Answer

Add LTRA to current therapy

Answer

Switch to daily oral corticosteroids

Answer

Add scheduled nebulized albuterol

Question 2

Which inhaler device requires the LEAST patient coordination between actuation and inhalation?

Accepted Answer

Nebulizer

Answer

Metered-dose inhaler (MDI)

Answer

Dry powder inhaler (DPI)

Answer

Soft mist inhaler (SMI)

Question 3

A COPD patient with blood eosinophils of 350 cells/μL continues to exacerbate frequently despite LABA/LAMA therapy. What is the most appropriate add-on treatment?

Accepted Answer

Adding ICS to create LABA/LAMA/ICS triple therapy

Answer

Scheduled short-acting beta-agonist four times daily

Answer

Switching to an oral beta-agonist

Answer

Adding azithromycin prophylaxis without ICS

Question 4

A patient with severe persistent asthma requires antihypertensive therapy. Which antihypertensive class is CONTRAINDICATED due to risk of bronchospasm?

Accepted Answer

Non-selective beta-blockers

Answer

ACE inhibitors

Answer

Calcium channel blockers

Answer

Angiotensin receptor blockers (ARBs)

Question 5

An MTM pharmacist reviews a patient's peak flow diary showing morning dipping greater than 20%. This finding is MOST consistent with which condition?

Accepted Answer

Poorly controlled asthma

Answer

Well-controlled asthma

Answer

COPD exacerbation

Answer

Pulmonary fibrosis

Question 6

Roflumilast (Daliresp) is indicated as add-on therapy for which COPD patient population?

Accepted Answer

Severe COPD with chronic bronchitis phenotype and frequent exacerbations

Answer

All COPD patients with FEV1 < 50% predicted

Answer

Asthma patients uncontrolled on ICS/LABA

Answer

COPD patients with predominantly emphysema phenotype

Question 7

A patient with exercise-induced bronchoconstriction (EIB) requests pre-exercise prophylaxis. Which recommendation is MOST appropriate?

Accepted Answer

Inhaled SABA (albuterol) 15-30 minutes before exercise

Answer

Oral montelukast taken 2 hours before exercise daily

Answer

Long-acting beta-agonist 30 minutes before each exercise session

Answer

Inhaled corticosteroid immediately before exercise