NAECB Asthma Medication 5 ā Questions and Answers
Question 1: Which inhaled corticosteroid is a prodrug activated by esterases in the lung, designed to minimize systemic bioavailability?
- Fluticasone propionate
- Budesonide
- Ciclesonide (Correct answer)
- Triamcinolone acetonide
Correct answer: Ciclesonide
Ciclesonide is an ICS prodrug converted to active des-ciclesonide by airway esterases, reducing oropharyngeal deposition and systemic effects.
Question 2: A patient develops oropharyngeal candidiasis after starting ICS therapy. What is the FIRST recommended intervention?
- Discontinue ICS immediately and switch to LTRA
- Use a spacer/valved holding chamber and rinse mouth after each dose (Correct answer)
- Switch to a prodrug ICS like ciclesonide
- Add prophylactic oral fluconazole daily
Correct answer: Use a spacer/valved holding chamber and rinse mouth after each dose
Using a spacer reduces oropharyngeal drug deposition, and rinsing the mouth after use removes residual ICS to prevent candidiasis.
Question 3: Benralizumab (Fasenra) reduces eosinophils more rapidly than mepolizumab. What is its mechanism compared to anti-IL-5 agents?
- It blocks IL-5 cytokine directly
- It binds IL-5 receptor alpha (IL-5RĪ±) and induces ADCC of eosinophils (Correct answer)
- It blocks IL-4RĪ± shared by eosinophil signaling
- It neutralizes free IgE bound to eosinophil surfaces
Correct answer: It binds IL-5 receptor alpha (IL-5RĪ±) and induces ADCC of eosinophils
Benralizumab binds IL-5RĪ± directly on eosinophils and triggers antibody-dependent cell-mediated cytotoxicity (ADCC), rapidly depleting eosinophils.
Question 4: Exercise-induced bronchoconstriction (EIB) prophylaxis with a SABA should be administered how long before exercise?
- Immediately before starting exercise
- 15ā30 minutes before exercise (Correct answer)
- 60ā90 minutes before exercise
- 2 hours before exercise
Correct answer: 15ā30 minutes before exercise
Albuterol MDI taken 15ā30 minutes before exercise provides effective prophylaxis against EIB for approximately 2ā3 hours.
Question 5: Which asthma medication class is CONTRAINDICATED in patients with a known hypersensitivity to aspirin who have asthma and nasal polyps (Samter's triad)?
- Inhaled corticosteroids
- Leukotriene modifiers
- Ketorolac or NSAIDs used as adjunct anti-inflammatory agents (Correct answer)
- Long-acting beta-2 agonists
Correct answer: Ketorolac or NSAIDs used as adjunct anti-inflammatory agents
In Samter's triad (AERD), NSAIDs including ketorolac trigger severe bronchoconstriction by diverting arachidonic acid to leukotriene synthesis.
Question 6: At GINA Step 5, which is the preferred add-on therapy for severe uncontrolled eosinophilic asthma before considering oral corticosteroids?
- Theophylline SR
- Add-on biologic therapy targeting type 2 inflammation (Correct answer)
- High-dose tiotropium
- Sublingual allergen immunotherapy
Correct answer: Add-on biologic therapy targeting type 2 inflammation
GINA Step 5 recommends add-on biologic therapy (e.g., anti-IL-5, anti-IgE, anti-IL-4/13) over chronic oral corticosteroids due to better safety profiles.
Question 7: A child uses a DPI for asthma. At what minimum inspiratory flow rate (L/min) are most DPIs optimally effective?
- 15 L/min
- 30 L/min (Correct answer)
- 60 L/min
- 90 L/min
Correct answer: 30 L/min
Most DPIs require a minimum inspiratory flow of approximately 30 L/min to deaggregate the powder for lung deposition, though 60 L/min is optimal.
NAECB Asthma Medication 5
Which inhaled corticosteroid is a prodrug activated by esterases in the lung, designed to minimize systemic bioavailability?