116 Questions
What is the recommended dosing of fluticasone propionate in Step 2 of asthma management?
100-250 mcg twice daily
What is the recommended dosing of salmeterol in Step 3 of asthma management?
50 mcg twice daily
At what FEV1 level range may a patient be when considering increasing the dose of IGC in Step 4?
60-80% predicted
What is the next step advised for patients with severe uncontrolled asthma despite Step 4 treatment?
Consult a specialist and consider alternative therapies
What is the recommended emergency evaluation criteria for persons with signs and symptoms suggestive of respiratory compromise?
Respiratory rate >30/min, pulse rate >120 beats per minute, O2 saturation <90% on room air
In asthma management, how often do patients experience symptoms 'Daily' according to the text?
Every day
Which lung function test result indicates a severe limitation on normal activity in asthma patients?
FEV1 >60% but <80% of predicted
What is the recommended respiratory rate threshold indicating a need for emergency evaluation in persons with signs and symptoms suggestive of respiratory compromise?
>30/min
Which parameter is used to assess the effect on normal activity in asthma patients?
Lung function tests
In asthma management, what level of FEV1 indicates a normal lung function between exacerbations?
>80% of predicted
Which of the following symptoms is NOT a clinical hallmark of asthma?
Sore throat
What is the recommended action for patients with PEF values below 50% predicted or personal best?
Immediate medical care
What initial treatment is recommended for less severe signs and symptoms of an asthma attack?
Inhaled SABA
Which sign or symptom should lead to immediate medical attention after initial treatment for a high-risk asthma attack patient?
Marked breathlessness
In asthma management, what level of PEF would indicate a Poor Response to initial treatment?
PEF is 50%–79% predicted or personal best
Which symptom assessment corresponds to a Marked wheezing and dyspnea response to asthma treatment?
Persistent wheezing and dyspnea
When assessing the effect on normal activity in asthma patients, which lung function test result would indicate Severe limitation?
FEV1 >60% but <80% of predicted
Which factor increases the risk of asthma exacerbations, even if the patient is experiencing few asthma symptoms?
High SABA use
When should risk factors for poor asthma outcomes be assessed?
At diagnosis and every 1-2 years
What lung function test should be measured periodically for ongoing assessment in asthma patients?
FEV1
Which of the following is NOT a risk factor for poor asthma outcomes?
High ICS adherence
What is a significant risk factor for exacerbations in asthma patients?
>1 x 200-dose canister/month of SABA use
How often should FEV1 be measured in asthma patients for ongoing assessment?
Periodically for ongoing assessment
What is the recommended frequency for assessing risk factors for poor asthma outcomes?
Every 1-2 years
Which of the following is considered an important risk factor for asthma exacerbations?
High SABA use
What lung function should be measured at the start of treatment and periodically for ongoing assessment in asthma patients?
FEV1
Which of the following increases the risk of asthma exacerbations, even if the patient is experiencing few asthma symptoms?
Incorrect inhaler technique
What does a patient experience if needing reliever medication more than twice a week in the past 4 weeks?
Uncontrolled asthma
Which risk factor for poor asthma outcomes has an increased mortality risk if exceeding more than one 200-dose canister per month?
High SABA use
What is the recommended controller choice for asthma patients with symptoms more often than twice a month and waking due to asthma more than once a month?
Medium-dose ICS + LTRA
For purely seasonal allergic asthma, when should ICS treatment be started?
Immediately upon onset of symptoms
In Step 3 of asthma management, what is a preferred controller option besides low-dose ICS/LABA?
Tiotropium by mist inhaler
What is a recommended controller choice for patients with a history of exacerbations in Step 4 of asthma management?
High-dose ICS/LABA
In Step 2 of asthma management, what is an alternative controller option to low-dose ICS?
Leukotriene receptor antagonist (LTRA)
For patients with purely seasonal allergic asthma, when should the use of ICS be discontinued?
After 4 weeks of exposure
In Step 3 of asthma management, what is an alternative to low-dose ICS/LABA as a preferred controller choice?
Medium-dose ICS + LTRA
What is the recommended daily dosage range for budesonide suspension for nebulization in children aged 1-8 years?
250-500 mcg/day
What is the recommended dosage of montelukast (Singulair) for a 6-year-old patient?
One 5-mg chewable tablet every evening
What is the correct dosage of beclomethasone dipropionate (QVAR) MDI for adults?
40-320 mcg twice daily
What is the recommended dosage of zafirlukast (Accolate) for a 13-year-old patient?
20-mg twice daily
What is the recommended dosage range for fluticasone propionate (Flovent Diskus) DPI in children aged 4-11 years?
50-100 mcg twice daily
What is the initial dosage of albuterol (ProAir HFA) for children using a solution for nebulization?
0.63–2.5 mg/kg every 4–6 h PRN
What is the correct dosing schedule for mometasone furoate (Asmanex Twisthaler) DPI in children aged 4-11 years?
110 mcg once daily
What is the recommended dosage of formoterol (Foradil Aerolizer) for adults using a DPI?
1 inhalation every 12 h
What is the recommended dosage of ciclesonide (Alvesco) MDI for children aged 12 years and above?
80-320 mcg twice daily
What is the dosage of ipratropium (Atrovent HFA) for nebulization in a patient who requires it four times daily?
500 mcg/vial
What is the correct dosage range for flunisolide (AeroBid) MDI in children aged 6-11 years?
160-320 mcg twice daily
What is the correct daily dosage of tiotropium (Spiriva) for patients using HandiHaler DPI?
18 mcg once daily
What is the recommended dosing for budesonide/formoterol (Symbicort) HFA 160 mcg/4.5 mcg?
2 inhalations twice daily
How many times a day is Combivent Respimat Inhaler (ipratropium/albuterol) recommended to be used?
4 times daily
What is the formulation per inhalation for Stiolto Respimat Inhaler (olodaterol/tiotropium)?
2.5 mcg olodaterol/2.5 mcg tiotropium
What is the recommended dosing for Mometasone/formoterol (Dulera) HFA 100 mcg/5 mcg?
2 inhalations twice daily
How many times a day should Utibron Neohaler Inhaler (indacaterol/glycopyrronium) be used?
Twice daily
What is the formulation per inhalation for Anoro Ellipta Inhaler (umeclidinium/vilanterol)?
62.5 mcg umeclidinium/25 mcg vilanterol
Which adverse effect is commonly associated with theophylline therapy in elderly men with prostatism?
Difficulty in urination
What is the recommended serum concentration range of theophylline at steady state?
5–15 mcg/mL
Which factor is essential due to wide interpatient variability in theophylline metabolic clearance?
Routine serum theophylline level monitoring
What adverse effects are commonly associated with inhaled short-acting β2 agonists?
Tachycardia and skeletal muscle tremor
What is a characteristic of ipratropium when used in the ED setting?
It provides less bronchodilation compared to SABAs
What does the combination of ipratropium with albuterol nebulizer solution contain to prevent discoloration?
EDTA
What is the advantage of administering corticosteroids for long-term treatment of severe persistent asthma on alternate days?
To reduce the risk of adrenal suppression
Which side effect is associated with inhaled long-acting β2 agonists like salmeterol and formoterol?
Tachycardia
What precaution should be taken when administering zafirlukast for asthma treatment?
Monitor hepatic enzymes (ALT) regularly
What is a dose-related acute toxicity associated with theophylline use in asthma patients?
Tachycardia
What is a potential complication of using budesonide/formoterol for asthma management?
Diminished bronchoprotective effects
Which enzyme inhibition can occur due to zileuton usage in asthma patients?
Microsomal P450 enzyme inhibition
What is a potential reversible abnormality in glucose metabolism associated with short-term use of systemic corticosteroids?
Hyperglycemia
In addition to weight gain, which of the following is another adverse effect associated with the use of systemic corticosteroids?
Muscle weakness
What condition should be considered for worsened outcomes if coexisting with systemic corticosteroid use?
Osteoporosis
For how long should a short course 'burst' of systemic corticosteroids typically be continued until the patient achieves 80% PEF or symptom resolution?
10-14 days
'There is no evidence that tapering the dose after improvement prevents relapse in asthma exacerbations' implies which of the following?
Tapering the dose is essential for preventing relapse.
Which other systemic corticosteroid is likely to be as effective as prednisolone when given in equipotent daily doses?
Hydrocortisone
'May be used in place of a short burst of oral steroids in patients who are vomiting or if adherence is a problem' refers to the usage of which medication?
Methylprednisolone acetate Repository injection
'Action may begin within an hour.' indicates the rapid onset of action of which medication?
Methylprednisolone acetate Repository injection
'Consideration should be given to coexisting conditions that could be worsened by systemic corticosteroids' includes all EXCEPT:
'Hyperthyroidism'
'May require longer' refers to what aspect of treatment with systemic corticosteroids?
'Duration'
What is the recommended action to reduce exposures to domestic dust mite allergens?
Replace carpets with linoleum or wood flooring
How should patients and parents handle exposure to tobacco smoke based on the text?
Stay away from tobacco smoke
What action should be taken to reduce exposure to allergens from animals with fur?
Remove animals from the home, or at least from the sleeping area
Which action reduces exposure to indoor mold according to the text?
Reduce dampness in the home and clean any damp areas frequently
How should physical activity be managed for asthma patients according to the text?
Prevent symptoms by taking certain medications before exercise
What is the recommended method for assessing pulmonary function in asthma management, as emphasized in the text?
Monitoring with peak expiratory flow meters
Why is it important for individuals with moderate to severe asthma to monitor their PEF levels at home?
To assess their response to treatment accurately
In the context of asthma management, what is the purpose of the zone system that uses green, yellow, and red zones?
To assist patients in interpreting their symptoms and PEF results
What does the yellow zone in the zone system for asthma management suggest about a patient's condition?
Their condition is deteriorating and requires caution
Why is it important to reassess an individual's personal best PEF periodically in asthma management?
To account for any progression in the severity of their disease
What is the significance of the yellow zone in an asthma action plan?
It signals a deterioration in airway obstruction that needs intervention
What immediate actions are recommended in the red zone of an asthma action plan?
Use inhaled rescue bronchodilator therapy and initiate or increase oral corticosteroids
What is the central focus for improving asthma adherence according to the text?
Therapeutic provider-patient relationship
Why is it recommended for patients with chronic severe asthma to be evaluated by an asthma specialist after a hospitalization?
To prevent future exacerbations and improve control
What has been the impact of obesity on asthma outcomes according to the information provided?
Obesity is associated with worsened asthma control and increased risk of morbidity
Why is it recommended for pregnant women with asthma to monitor pulmonary function throughout pregnancy?
To detect a 20% drop in peak flow that often precedes symptoms
Why does asthma tend to be less well recognized among older adults?
Because older adults often have symptoms that mimic other respiratory ailments
What is a key consideration when managing asthma in pregnant women?
Maintaining good asthma control before and during pregnancy
Why is it important to distinguish between asthma and COPD in older adults?
Because the treatment approaches differ for each condition
What is a characteristic of asthma management in older adults?
Older adults generally experience symptoms at a later age than younger individuals
What may enhance drug delivery in older adults with asthma?
Spacers
What is a common complication of asthma that is characterized by symptoms not improving with initial treatment?
Status asthmaticus
Which factor has been identified to increase the risk of fatal asthma?
Comorbidity such as cardiovascular disease
What is recommended for patients with signs and symptoms suggestive of respiratory compromise?
Early intubation
What is a significant challenge in patient education related to asthma management?
Ongoing maintenance and prevention requirements
What should patients and their families be well educated about in order to achieve goals of asthma treatment besides episodic relief of symptoms?
Understanding the role of airway inflammation in asthma
What is the definition of asthma control?
Being able to engage in normal activities without limitations
What is the purpose of long-term control medications in asthma treatment according to the text?
To prevent symptoms by reducing inflammation
What self-monitoring skills are asthma patients advised to have that are tied to an action plan?
Recognizing intensity and frequency of asthma symptoms
What is a key aspect of the written Asthma Action Plan (AAP) that patients should be familiar with?
Instructions for recognizing and handling worsening asthma only
What is a key focus area during subsequent visits for asthma patients, as recommended in the text?
Reviewing asthma control and medications
What specific technique should be taught or reviewed for asthma management, as highlighted in the text?
Peak flow monitoring technique
Which aspect of asthma management should patients be educated on in simple language, according to the text?
Medication self-assessment
What is a crucial step to confirm during patient education regarding asthma exacerbations, as mentioned in the text?
Confirming patients' knowledge of what to do if asthma worsens
Which item should be reviewed and demonstrated to patients for effective asthma management, per the text?
Inhaler/spacer technique
In the context of asthma management, what should patients be confirmed to know in case of worsening symptoms?
What to do if asthma gets worse
Which factor should be prioritized during patient education sessions for effective asthma control?
'Asthma control and medications'
What type of assessment should patients be able to perform for asthma control, as indicated in the text?
'Self-assessment of asthma control'
'Quality of life' is mentioned as an important focus area during subsequent visits to assess what aspect of asthma management?
'Quality of life' related to asthma management
'Teach or review and demonstrate' are actions recommended for which specific technique in the text?
'Inhaler/spacer or VHC technique'
Test your knowledge on asthma management steps, dosing details, and FEV1 levels associated with each step. Learn about using reliever medications, low-dose inhaled glucocorticoids, and add-on therapies to control asthma symptoms.
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