NAECB Asthma Medication 4 — Questions and Answers
Question 1: Tezepelumab (Tezspire) is unique among approved asthma biologics because it targets which upstream cytokine, making it effective regardless of eosinophil count?
- IL-33
- IL-4
- TSLP (thymic stromal lymphopoietin) (Correct answer)
- IL-25 (IL-17E)
Correct answer: TSLP (thymic stromal lymphopoietin)
Tezepelumab targets TSLP, an epithelial-derived cytokine upstream of all type 2 inflammatory pathways, providing broad efficacy.
Question 2: A patient with aspirin-exacerbated respiratory disease (AERD) and asthma would MOST benefit from which add-on therapy?
- Theophylline
- Leukotriene receptor antagonist (LTRA) (Correct answer)
- Long-acting beta-2 agonist (LABA)
- Tiotropium
Correct answer: Leukotriene receptor antagonist (LTRA)
AERD involves overproduction of cysteinyl leukotrienes, so LTRAs specifically blunt this pathway and improve both asthma and NSAID sensitivity.
Question 3: Which systemic corticosteroid course is recommended by NAEPP for an adult with a moderate-severe acute asthma exacerbation at hospital discharge?
- 3–5 day course of prednisone 40–60 mg/day (Correct answer)
- Single-dose dexamethasone 8 mg IM
- 7-day tapering course starting at 80 mg/day
- Inhaled budesonide increased to high-dose only
Correct answer: 3–5 day course of prednisone 40–60 mg/day
NAEPP recommends a 3–5 day course of oral prednisone (40–60 mg/day) after acute exacerbation to prevent relapse.
Question 4: Cromolyn sodium prevents asthma by which mechanism?
- Blocking muscarinic receptors in bronchial smooth muscle
- Stabilizing mast cell membranes to prevent degranulation (Correct answer)
- Inhibiting phosphodiesterase to increase cAMP
- Blocking leukotriene receptors on bronchial epithelium
Correct answer: Stabilizing mast cell membranes to prevent degranulation
Cromolyn sodium stabilizes mast cell membranes, preventing the release of inflammatory mediators upon allergen exposure.
Question 5: Which formoterol-containing combination ICS/LABA inhaler is FDA-approved for use as BOTH maintenance AND reliever therapy (MART/SMART strategy)?
- Fluticasone/salmeterol (Advair)
- Fluticasone/vilanterol (Breo Ellipta)
- Budesonide/formoterol (Symbicort) (Correct answer)
- Mometasone/formoterol (Dulera)
Correct answer: Budesonide/formoterol (Symbicort)
Budesonide/formoterol (Symbicort) uses formoterol's rapid onset to allow single-inhaler maintenance and reliever therapy (SMART).
Question 6: A patient with severe persistent asthma and a serum total IgE of 380 IU/mL and confirmed allergic sensitization is a candidate for which biologic?
- Mepolizumab (Nucala)
- Omalizumab (Xolair) (Correct answer)
- Benralizumab (Fasenra)
- Dupilumab (Dupixent)
Correct answer: Omalizumab (Xolair)
Omalizumab binds free IgE and is indicated for moderate-to-severe allergic asthma with elevated IgE (30–700 IU/mL) and positive allergen skin tests.
Question 7: What is the primary reason magnesium sulfate IV is used in severe acute asthma exacerbations refractory to initial treatment?
- It enhances mucociliary clearance
- It causes bronchodilation by blocking calcium-mediated smooth muscle contraction (Correct answer)
- It reduces eosinophil migration into airways
- It potentiates the effect of systemic corticosteroids
Correct answer: It causes bronchodilation by blocking calcium-mediated smooth muscle contraction
Magnesium sulfate blocks calcium influx in bronchial smooth muscle, producing bronchodilation in severe refractory exacerbations.
NAECB Asthma Medication 4
Tezepelumab (Tezspire) is unique among approved asthma biologics because it targets which upstream cytokine, making it effective regardless of eosinophil count?