NAPLEX Question of the Week: Asthma

Asthma is a very common disease state in both pediatrics and adults. Pharmacists are often involved in the care of these patients especially with patient education on administration of the type of device. There are a number of types of inhalers/devices used by patients with multiple medications often in the same inhaler. This question focuses on that aspect of care.

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A 48 year old male with past medical history of hypothyroidism, asthma, and hypertension presents to his PCM with a primary complaint of persistent shortness of breath. He has increased use of his short-acting albuterol MDI to twice daily in response to shortness of breath which has persisted over the last month (not related to infectious illness). He also takes fluticasone propionate 110mcg 2 puffs BID.  He also currently takes levothyroxine 100mcg orally daily and lisinopril 20mg daily. Vitals and labs are WNL. His provider wishes to initiate a combination long-acting beta agonist with inhaled corticosteroid combination in one inhaler/diskus. Which of the following contains both of these medications? Select all that apply.

A. Symbicort

B. Breo Ellipta

C. Dulera

D. Advair HFA

E. Arnuity Ellipta

Answers with Rationale:

The correct answers are A, B, C, and D. Each of these branded correct drug choices has both an inhaled corticosteroid and a long acting beta agonist. It is important to note that questions may be asked on the examination either by brand name or generic name so it is imperative to know both despite most formal education in pharmacy schools focusing on generic names. Symbicort contains budesonide/formoterol, Breo Ellipta contains fluticasone furoate/vilanterol, Dulera contains mometasone/formoterol, and Advair HFA contains fluticasone propionate/salmeterol. Arnuity Ellipta contains only a corticosteroid (fluticasone furoate) so answer E is incorrect. Caution with the "Ellipta" formulations as there have been a number of dispensing errors due to similarity and confusion with products.

For studying purposes, types of devices such as MDI, diskus, nebs etc. should be reviewed with appropriate dosages as this often is an area of confusion for patients. Additionally administration techniques with each device should  be reviewed in order to ensure patients are using proper technique when administering the medication(s).

Here is a nice table from Pharmacotherapy: A Pathophysiologic Approach regarding medications used in COPD/Asthma:

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.