Use ICS monotherapy for this, not that. For asthma COPD overlap, don't use that, use this. Try these 4 questions on GINA and GOLD recommended treatments.
Symptoms of asthma and COPD can sometimes overlap, complicating diagnosis and treatment. This quiz tests your knowledge of guideline-recommended issues surrounding treatment of asthma, COPD and asthma/COPD overlap, ie, when to use this, and not that.
Answer: B. ICS monotherapy is recommended as initial treatment in asthma but not in COPD. According to 2019 recommendations from the global initiative for asthma, inhaled corticosteroids (ICSs) are recommended as initial treatment in asthma, with add-on long-acting beta2 agonists (LABA) and/or long-acting muscarinic agonists (LAMA) as needed.1 According to GOLD 2020 recommendations, initial treatment of COPD should be based on GOLD criteria. Initial treatment generally includes LABAs and/or LAMAs) or combination therapy. ICS monotherapy is not recommended as initial treatment in COPD.2
2. Which of the above medications should be avoided in patients with symptoms of asthma/COPD overlap?
Answer: D. LABA monotherapy. According to 2019 GINA recommendations, the default approach in patients with asthma/COPD overlap is to treat for asthma until a confirmatory diagnosis can be made. In these patients, initial treatment with low or moderate dose ICS is recommended, due to the role ICS play in decreasing morbidity and mortality in uncontrolled asthma. While add-on LABA and/or LAMA therapy is usually needed, LABA monotherapy should be avoided in patients with asthma symptoms because it has been associated with increased risk of asthma exacerbations and mortality.1,2
3. Which of the medications above has adequate safety and effectiveness data for use in children aged ≥1 yr?
Answer: C. Pulmicort (budesonide) inhaler. The 2019 GINA recommendations state that regular use of low-dose ICS as controller medication may be indicated in children aged <5 years with a symptom pattern suggesting asthma; uncontrolled symptoms; and/or severe or frequent wheezing episodes >3 times/season. The Pulmicort nebulizer is the only medication with adequate safety and efficacy data in children aged ≥1 year. For the Flovent and Asmanex inhalers, adequate safety/efficacy data are available for children aged ≥4 yrs. For the Qvar inhaler, safety/efficacy data are available only for children aged ≥5 yrs.
Answer: A. Theophylline. According to 2020 GOLD criteria, LABAs (salmeterol, formoterol) and LAMAs (tiotropium bromide) are preferred to short-acting agents in patients with stable COPD, except in patients who have only occasional dyspnea. These agents are also recommended for symptomatic relief in stable patients who are already on maintenance therapy with long-acting bronchodilators. Theophylline, a smooth muscle relaxant, is not recommended unless other long-acting bronchodilators are not available or not affordable.