Chapter 14. Asthma
A 23-year-old patient comes into clinic for asthma follow-up. Which of the following would be concerning about the patient's use of albuterol HFA MDI?
A. She uses 2 canisters of albuterol in 1 month.
B. She primes her inhaler prior to the initial use.
C. She uses 2 inhalations prior to beginning exercise.
D. She waits 30 seconds between each inhalation.
Option A: Correct. Using 2 canisters of albuterol in 1 month is concerning. This means that the patient is using 200 doses of albuterol in 1 month. Using albuterol more than twice in 1 week indicates poor asthma control if the patient is using the inhaler correctly.
Option B: Incorrect. Priming the inhaler prior to the initial use is recommended for the inhaler to work correctly. Priming the inhaler if it has not been used for period of time (7 to 10 days for most albuterol inhalers) is also recommended.
Option C: Incorrect. Using albuterol prior to initiating exercise is recommended so the patient does not have to stop during exercise because of coughing or shortness of breath. Using the inhaler prior to exercise is not considered when assessing the patient for uncontrolled asthma.
Option D: Incorrect. Waiting 30 seconds between inhalations allows the canister to recalibrate to deliver a full second dose of medication.
A 35-year-old man has all of his asthma medications with him today. Which of the following is duplication of therapy?
A. Budesonide/formoterol and tiotropium
B. Montelukast and budesonide/formoterol
C. Albuterol and prednisone
D. Budesonide/formoterol and salmeterol
Option A: Incorrect. Budesonide is an inhaled corticosteroid, formoterol is a long-acting β2-agonist, and tiotropium is a long-acting muscarinic antagonist. All three medications can be used effectively together.
Option B: Incorrect. Montelukast is a leukotriene receptor antagonist, budesonide is an inhaled corticosteroid, and formoterol is a long-acting β2-agonist. All three medications can be used effectively together.
Option C: Incorrect. Albuterol is a short-acting β2-agonist and prednisone is an oral corticosteroid. Both are used for asthma exacerbations.
Option D: Correct. Budesonide is an inhaled corticosteroid, formoterol is a long-acting β2-agonist (LABA), and salmeterol is also a LABA. Using a LABA alone is contraindicated for asthma patients and increases the risk for death. Using formoterol and salmeterol together will ...