NAECB Asthma Education 4 — Questions and Answers
Question 1: A pregnant patient with previously well-controlled asthma presents with worsening symptoms during the second trimester. What is the recommended approach?
- Discontinue all asthma medications to protect the fetus
- Step down therapy to minimize fetal exposure
- Continue or adjust controller therapy to maintain control, as uncontrolled asthma poses greater fetal risk (Correct answer)
- Switch to oral corticosteroids only, avoiding inhaled medications
Correct answer: Continue or adjust controller therapy to maintain control, as uncontrolled asthma poses greater fetal risk
Uncontrolled asthma during pregnancy poses greater risk to the fetus than properly used asthma medications, so maintaining control is the priority.
Question 2: Which of the following is the MOST appropriate outcome measure for evaluating the effectiveness of an asthma education intervention?
- Patient satisfaction scores alone
- Number of educational sessions attended
- Reduction in emergency department visits and hospitalizations (Correct answer)
- Patient's recall of inhaler device names
Correct answer: Reduction in emergency department visits and hospitalizations
Reduced emergency department visits and hospitalizations are clinical outcome measures that directly reflect improved asthma management.
Question 3: A patient reports that their asthma symptoms worsen when they take ibuprofen. This pattern is most consistent with which condition?
- Allergic asthma triggered by NSAID excipients
- Aspirin-exacerbated respiratory disease (AERD) (Correct answer)
- Beta-blocker induced bronchospasm
- Vocal cord dysfunction mimicking asthma
Correct answer: Aspirin-exacerbated respiratory disease (AERD)
AERD (also called Samter's triad) involves asthma, nasal polyps, and sensitivity to NSAIDs including aspirin and ibuprofen.
Question 4: When assessing a patient's health literacy, which approach is most effective for confirming understanding of inhaler technique?
- Asking 'Do you understand how to use your inhaler?'
- Providing a detailed written pamphlet to read at home
- Using the teach-back method and asking the patient to demonstrate the technique (Correct answer)
- Having family members confirm the patient understands
Correct answer: Using the teach-back method and asking the patient to demonstrate the technique
The teach-back/demonstrate-back method is the gold standard for confirming procedural understanding and correcting errors in real time.
Question 5: Long-acting beta-agonists (LABAs) should NEVER be used in asthma without which concurrent therapy?
- A leukotriene receptor antagonist
- An inhaled corticosteroid (Correct answer)
- An oral corticosteroid
- An anti-IgE biologic
Correct answer: An inhaled corticosteroid
LABAs carry an FDA black box warning and must always be combined with an ICS in asthma due to risk of asthma-related death when used as monotherapy.
Question 6: A patient with asthma also has gastroesophageal reflux disease (GERD). How does GERD relate to asthma management?
- GERD does not affect asthma and can be managed independently
- GERD can trigger or worsen asthma symptoms through microaspiration and vagal reflexes (Correct answer)
- GERD always indicates that the patient's asthma diagnosis is incorrect
- Treating GERD is contraindicated in asthma patients on ICS
Correct answer: GERD can trigger or worsen asthma symptoms through microaspiration and vagal reflexes
GERD can worsen asthma through acid microaspiration and reflex bronchoconstriction, and treating GERD may improve asthma control.
Question 7: Which of the following is a hallmark feature of asthma that distinguishes it from COPD on spirometry?
- FEV1/FVC ratio always below 0.50
- Significant reversibility of airflow obstruction (≥12% and 200 mL improvement in FEV1) after bronchodilator (Correct answer)
- Total lung capacity consistently below normal
- No response to any bronchodilator therapy
Correct answer: Significant reversibility of airflow obstruction (≥12% and 200 mL improvement in FEV1) after bronchodilator
Significant post-bronchodilator reversibility (≥12% and ≥200 mL increase in FEV1) strongly supports asthma over COPD.
NAECB Asthma Education 4
A pregnant patient with previously well-controlled asthma presents with worsening symptoms during the second trimester.
What is the recommended approach?