MTM Respiratory Disease Management 2 — Questions and Answers
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?
- Add LTRA to current therapy
- Step up to medium-dose ICS/LABA (Correct answer)
- Switch to daily oral corticosteroids
- Add scheduled nebulized albuterol
Correct answer: Step up to medium-dose ICS/LABA
GINA Step 4 involves increasing ICS dose while maintaining LABA, advancing from low-dose to medium-dose ICS/LABA combination therapy.
Question 2: Which inhaler device requires the LEAST patient coordination between actuation and inhalation?
- Metered-dose inhaler (MDI)
- Dry powder inhaler (DPI)
- Soft mist inhaler (SMI)
- Nebulizer (Correct answer)
Correct answer: Nebulizer
Nebulizers continuously convert liquid medication to fine mist, requiring minimal patient coordination and making them ideal for patients with poor inhaler technique.
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?
- Scheduled short-acting beta-agonist four times daily
- Adding ICS to create LABA/LAMA/ICS triple therapy (Correct answer)
- Switching to an oral beta-agonist
- Adding azithromycin prophylaxis without ICS
Correct answer: Adding ICS to create LABA/LAMA/ICS triple therapy
GOLD guidelines recommend adding ICS to LABA/LAMA (triple therapy) in COPD patients with eosinophils ≥300 cells/μL who continue to exacerbate on dual bronchodilation.
Question 4: A patient with severe persistent asthma requires antihypertensive therapy. Which antihypertensive class is CONTRAINDICATED due to risk of bronchospasm?
- ACE inhibitors
- Non-selective beta-blockers (Correct answer)
- Calcium channel blockers
- Angiotensin receptor blockers (ARBs)
Correct answer: Non-selective beta-blockers
Non-selective beta-blockers block beta-2 receptors in bronchial smooth muscle, precipitating life-threatening bronchospasm in asthma patients.
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?
- Well-controlled asthma
- COPD exacerbation
- Poorly controlled asthma (Correct answer)
- Pulmonary fibrosis
Correct answer: Poorly controlled asthma
Morning dipping in peak expiratory flow >20% (diurnal variation) is a hallmark of poorly controlled asthma reflecting significant airway variability.
Question 6: Roflumilast (Daliresp) is indicated as add-on therapy for which COPD patient population?
- All COPD patients with FEV1 < 50% predicted
- Severe COPD with chronic bronchitis phenotype and frequent exacerbations (Correct answer)
- Asthma patients uncontrolled on ICS/LABA
- COPD patients with predominantly emphysema phenotype
Correct answer: Severe COPD with chronic bronchitis phenotype and frequent exacerbations
Roflumilast, a PDE-4 inhibitor, is indicated for severe COPD patients with chronic bronchitis phenotype and ≥2 exacerbations per year despite standard therapy.
Question 7: A patient with exercise-induced bronchoconstriction (EIB) requests pre-exercise prophylaxis. Which recommendation is MOST appropriate?
- Oral montelukast taken 2 hours before exercise daily
- Inhaled SABA (albuterol) 15-30 minutes before exercise (Correct answer)
- Long-acting beta-agonist 30 minutes before each exercise session
- Inhaled corticosteroid immediately before exercise
Correct answer: Inhaled SABA (albuterol) 15-30 minutes before exercise
Inhaled SABA 15-30 minutes before exercise is the recommended prophylactic treatment for EIB due to its rapid onset and short duration of action.
MTM Respiratory Disease Management 2
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?