PULMO-ASTHMA Flashcards
According to the GINA 2023 guidelines for starting asthma treatment in adults and adolescents, which of the following is true about selecting the initial treatment approach (Track 1 vs. Track 2)?
A. Track 1 is preferred because it reduces the risk of severe exacerbations and simplifies reliever and maintenance treatment.
B. Track 2 involves using ICS-formoterol as both the controller and reliever.
C. Patients with symptoms occurring less than twice a month should begin with medium-dose maintenance ICS-formoterol.
D. Track 2 should only be considered if the patient is unlikely to adhere to daily controller treatment.
Correct Answer:
A. Track 1 is preferred because it reduces the risk of severe exacerbations and simplifies reliever and maintenance treatment.
Rationale:
Option A: Correct. The diagram clearly indicates that Track 1, which uses ICS-formoterol as the preferred controller and reliever, reduces the risk of severe exacerbations compared to using a SABA reliever and simplifies treatment.
Option B: Incorrect. ICS-formoterol as both controller and reliever is a feature of Track 1, not Track 2. Track 2 uses ICS-LABA and SABA as relievers.
Option C: Incorrect. For patients with symptoms less than twice a month, Track 1 recommends as-needed low-dose ICS-formoterol, not medium-dose ICS-formoterol.
Option D: Incorrect. The diagram specifies that Track 2 is considered an alternative approach, especially if the patient is likely to adhere to daily controller treatment, rather than if they are unlikely to adhere.
What is the recommended reliever treatment in Track 1 according to the GINA 2023 guidelines?
A. As-needed SABA
B. As-needed low-dose ICS-formoterol
C. Daily low-dose ICS-formoterol
D. Low-dose ICS + LABA
Correct Answer:
B. As-needed low-dose ICS-formoterol
Rationale: Track 1 uses ICS-formoterol as both a controller and reliever to reduce the risk of severe exacerbations and simplify treatment.
For patients with asthma symptoms occurring most days or waking with asthma once a week or more, which initial treatment step is recommended in Track 1?
A. Steps 1–2: As-needed low-dose ICS-formoterol
B. Step 3: Low-dose maintenance ICS-formoterol
C. Step 4: Medium-dose maintenance ICS-formoterol
D. Step 5: Add-on LAMA or biologic therapy
Correct Answer:
B. Step 3: Low-dose maintenance ICS-formoterol
Rationale: In Track 1, patients with frequent symptoms should start with Step 3 treatment (low-dose maintenance ICS-formoterol).
When should a short course of oral corticosteroids (OCS) be considered according to the GINA 2023 guidelines?
A. At Step 2 for patients with infrequent symptoms
B. Only in Track 2, Step 4
C. For patients presenting with severely uncontrolled asthma at any step
D. For all patients starting asthma treatment
Correct Answer:
C. For patients presenting with severely uncontrolled asthma at any step
Rationale: The diagram indicates that a short course of OCS may be needed for patients with severely uncontrolled asthma regardless of the treatment step.
What is the primary difference between Track 1 and Track 2 in the GINA 2023 guidelines?
A. Track 1 uses a SABA reliever, while Track 2 uses ICS-formoterol as a reliever.
B. Track 1 uses ICS-formoterol as both a controller and reliever, while Track 2 uses SABA or ICS-SABA as a reliever.
C. Track 1 requires daily controller use, while Track 2 does not.
D. Track 2 is only recommended for patients with severe asthma.
Correct Answer:
B. Track 1 uses ICS-formoterol as both a controller and reliever, while Track 2 uses SABA or ICS-SABA as a reliever.
Rationale: The key distinction is that Track 1 uses ICS-formoterol for both control and relief, whereas Track 2 involves alternative treatments with SABA or ICS-SABA as relievers.
In Track 2, what is the recommended treatment for patients with symptoms occurring twice a month or more but less than 4–5 days a week?
A. As-needed low-dose ICS-formoterol
B. Low-dose maintenance ICS
C. Medium-dose maintenance ICS-LABA
D. As-needed SABA
Correct Answer:
B. Low-dose maintenance ICS
Rationale: Track 2 recommends low-dose maintenance ICS for patients with symptoms in this frequency range, highlighting a more traditional approach compared to Track 1.
Which of the following is a symptom that supports the diagnosis of asthma?
A. Chest pain after eating heavy meals
B. Persistent isolated cough with no variability
C. Symptoms that vary over time and are triggered by exercise or allergens
D. Symptoms that appear only during sleep without worsening
Correct Answer:
C. Symptoms that vary over time and are triggered by exercise or allergens
Rationale:
Asthma symptoms are variable, may worsen with exercise, allergens, or viral infections, and typically vary over time. Persistent isolated cough without variability is uncommon for asthma.
What is the criterion for a positive bronchodilator responsiveness test in adults?
A. Increase in FEV₁ by >10% and >100 mL
B. Increase in FEV₁ by >12% and >200 mL
C. Increase in FEV₁ by >15% and >400 mL
D. Decrease in FEV₁ by >20%
Correct Answer:
B. Increase in FEV₁ by >12% and >200 mL
Rationale:
In adults, a positive bronchodilator test requires an increase in FEV₁ by >12% and >200 mL after bronchodilator administration.
hat defines excessive variability in twice-daily PEF over two weeks in adults?
A. Average daily diurnal PEF variability >15%
B. Average daily diurnal PEF variability >10%
C. Average daily diurnal PEF variability >20%
D. Average daily diurnal PEF variability <5%
Correct Answer:
B. Average daily diurnal PEF variability >10%
Rationale:
The table specifies that excessive variability in twice-daily PEF over two weeks is defined as >10% in adults.
Which of the following is a documented indication of variable expiratory airflow limitation in asthma?
A. A fall in FEV₁ of >20% after 4 weeks of ICS-containing treatment
B. Increase in FEV₁ by >12% and >200 mL after 4 weeks of ICS-containing treatment
C. Decrease in PEF by >10% during viral infections
D. Persistent FEV₁/FVC ratio >90%
Correct Answer:
B. Increase in FEV₁ by >12% and >200 mL after 4 weeks of ICS-containing treatment
Rationale:
An increase in FEV₁ by >12% and >200 mL after 4 weeks of ICS-containing treatment supports the diagnosis of variable expiratory airflow limitation.
What is the criterion for a positive exercise challenge test in adults?
A. Fall in FEV₁ of >10% and >200 mL from baseline
B. Increase in FEV₁ by >12% and >200 mL from baseline
C. Fall in FEV₁ of >15% and >400 mL from baseline
D. Decrease in PEF variability to <10% after exercise
Correct Answer:
A. Fall in FEV₁ of >10% and >200 mL from baseline
Rationale:
A positive exercise challenge test in adults is defined as a fall in FEV₁ of >10% and >200 mL from baseline.
Case Scenario
A 32-year-old male presents to the clinic with complaints of intermittent wheezing, chest tightness, and shortness of breath. His symptoms worsen during exercise and exposure to cold air. He reports that these symptoms have been occurring variably over the past year, with some days being worse than others. He also notes frequent nighttime awakenings due to breathing difficulty.
He undergoes spirometry testing, and the results are as follows:
Pre-bronchodilator FEV₁: 2.2 L (baseline)
Post-bronchodilator FEV₁: 2.6 L
Further evaluation with twice-daily PEF monitoring over two weeks shows an average daily diurnal PEF variability of 12%.
Based on this clinical scenario, answer the following questions:
Question 1: What feature from the patient’s history supports the diagnosis of asthma?
A. Symptoms that worsen with exercise and cold air exposure
B. Persistent cough without variability
C. Symptoms that are only present at night
D. Lack of response to medications
Correct Answer:
A. Symptoms that worsen with exercise and cold air exposure
Rationale:
Asthma symptoms are typically variable, worsened by triggers like exercise and cold air, and often involve wheezing, chest tightness, or shortness of breath.
Question 2: What is the interpretation of the bronchodilator reversibility test in this patient?
A. Positive, as the FEV₁ increased by 12% and 400 mL
B. Positive, as the FEV₁ increased by 18% and 400 mL
C. Negative, as the FEV₁ increase was less than 20%
D. Negative, as the FEV₁ increase was less than 15%
Correct Answer:
B. Positive, as the FEV₁ increased by 18% and 400 mL
Rationale:
A bronchodilator response is considered positive in adults if the FEV₁ increases by >12% and >200 mL. This patient’s increase of 18% and 400 mL meets this criterion.
Question 3: What does the patient’s PEF variability indicate?
A. It is within normal limits for adults.
B. It indicates excessive variability, supporting asthma diagnosis.
C. It rules out asthma as the cause of symptoms.
D. It indicates poor treatment adherence.
Correct Answer:
B. It indicates excessive variability, supporting asthma diagnosis.
Rationale:
Excessive variability in twice-daily PEF over two weeks is defined as >10% in adults. The patient’s variability of 12% supports the diagnosis of asthma.
Question 4: Based on GINA 2023 guidelines, which treatment track and step would be most appropriate for this patient?
A. Track 1, Step 1: As-needed low-dose ICS-formoterol
B. Track 1, Step 3: Low-dose maintenance ICS-formoterol
C. Track 2, Step 2: Low-dose ICS with as-needed SABA
D. Track 2, Step 4: Medium-dose maintenance ICS-LABA
Correct Answer:
B. Track 1, Step 3: Low-dose maintenance ICS-formoterol
Rationale:
The patient has persistent symptoms, including frequent nighttime awakenings. In Track 1, this corresponds to Step 3, which involves low-dose maintenance ICS-formoterol with as-needed low-dose ICS-formoterol as the reliever.
