NAECB Asthma Medication 3 — Questions and Answers
Question 1: A pregnant patient in her third trimester has moderate persistent asthma. Which ICS is considered the preferred agent due to the most safety data in pregnancy?
- Fluticasone furoate
- Ciclesonide
- Budesonide (Correct answer)
- Beclomethasone dipropionate
Correct answer: Budesonide
Budesonide has the most human pregnancy safety data and is the preferred ICS during pregnancy per NAEPP guidelines.
Question 2: Which adverse effect is MOST associated with long-term systemic corticosteroid use in pediatric asthma patients?
- Irreversible bronchospasm
- Growth suppression (Correct answer)
- Hepatotoxicity
- Peripheral neuropathy
Correct answer: Growth suppression
Long-term systemic corticosteroids in children can suppress the hypothalamic-pituitary axis and impair linear growth.
Question 3: Dupilumab (Dupixent) targets which cytokine pathway making it effective in eosinophilic and type 2 asthma?
- IL-5 receptor alpha
- IL-4/IL-13 via IL-4Rα blockade (Correct answer)
- IgE receptor (FcεRI)
- TSLP (thymic stromal lymphopoietin)
Correct answer: IL-4/IL-13 via IL-4Rα blockade
Dupilumab blocks IL-4Rα, inhibiting both IL-4 and IL-13 signaling, key drivers of type 2 inflammation.
Question 4: When stepping DOWN asthma therapy per GINA/NAEPP guidelines, what minimum period of symptom control should be achieved before reducing medication?
- 2 weeks
- 1 month
- 3 months (Correct answer)
- 6 months
Correct answer: 3 months
GINA recommends at least 3 months of good asthma control before considering step-down of controller therapy.
Question 5: A patient takes salmeterol (Serevent) as monotherapy without an ICS. What is the primary safety concern?
- Increased risk of paradoxical bronchospasm
- Increased risk of asthma-related death (black box warning) (Correct answer)
- Severe hypokalemia requiring monitoring
- Irreversible tachyphylaxis after 2 weeks
Correct answer: Increased risk of asthma-related death (black box warning)
LABA monotherapy (without ICS) carries an FDA black box warning for increased risk of asthma-related death.
Question 6: Which inhaler device requires NO coordination between actuation and inhalation, making it useful for patients who struggle with MDI technique?
- Metered-dose inhaler (MDI)
- Dry powder inhaler (DPI) (Correct answer)
- Soft mist inhaler (Respimat)
- Jet nebulizer
Correct answer: Dry powder inhaler (DPI)
Dry powder inhalers (DPIs) are breath-actuated, so drug delivery depends on the patient's inspiratory effort rather than manual coordination.
Question 7: Oral montelukast carries an FDA Boxed Warning added in 2020 regarding which serious adverse effect?
- Severe hepatotoxicity and liver failure
- Neuropsychiatric events including suicidal ideation (Correct answer)
- QT prolongation and cardiac arrhythmia
- Anaphylaxis and severe hypersensitivity
Correct answer: Neuropsychiatric events including suicidal ideation
The 2020 FDA Boxed Warning for montelukast warns about serious neuropsychiatric events including agitation, depression, and suicidal thinking.
NAECB Asthma Medication 3
A pregnant patient in her third trimester has moderate persistent asthma.
Which ICS is considered the preferred agent due to the most safety data in pregnancy?