Asthma MCQs With Answer

Asthma MCQs With Answer for B. Pharm students: This focused set of multiple-choice questions covers asthma pathophysiology, pharmacology, inhaler technique, guideline-based management, and drug adverse effects to strengthen clinical and dispensing skills. Questions emphasize mechanisms of bronchodilators, inhaled corticosteroids, leukotriene modifiers, biologics, anticholinergics, and emergency therapies, with attention to dosing, monitoring, and drug interactions relevant to pharmacists; they also cover spirometry interpretation, peak flow monitoring, inhaler device selection, and stepwise treatment decisions for acute and chronic care. This asthma pharmacology review targets drug action, side effects, and rational therapy. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which feature best defines asthma?

• Progressive irreversible airflow obstruction due to smoking
• Reversible airway obstruction with bronchial hyperresponsiveness
• Restrictive lung disease with decreased total lung capacity
• Primary alveolar destruction with macroscopic bullae

Correct Answer: Reversible airway obstruction with bronchial hyperresponsiveness

Q2. What is the primary mechanism of action of short-acting beta-2 agonists (SABAs) like salbutamol?

• Block muscarinic receptors in the airway smooth muscle
• Activate beta-2 adrenergic receptors to increase intracellular cAMP causing bronchodilation
• Inhibit phosphodiesterase IV to increase cAMP
• Antagonize leukotriene receptors to reduce bronchoconstriction

Correct Answer: Activate beta-2 adrenergic receptors to increase intracellular cAMP causing bronchodilation

Q3. Which inhaled medication is the cornerstone controller therapy for persistent asthma?

• Short-acting beta-2 agonist
• Leukotriene receptor antagonist
• Inhaled corticosteroid
• Theophylline

Correct Answer: Inhaled corticosteroid

Q4. Which of the following indicates significant bronchodilator reversibility on spirometry?

• FEV1 increase of ≥12% and ≥200 mL after bronchodilator
• FEV1/FVC ratio decreasing by 10% after bronchodilator
• FVC increase of 20% after bronchodilator
• FEV1 increase of 5% with any volume change

Correct Answer: FEV1 increase of ≥12% and ≥200 mL after bronchodilator

Q5. Montelukast belongs to which class of anti-asthma drugs?

• Long-acting beta-2 agonist
• Leukotriene receptor antagonist
• Anti-IgE monoclonal antibody
• Mast cell stabilizer

Correct Answer: Leukotriene receptor antagonist

Q6. Which biologic therapy targets IgE and is used in allergic severe asthma?

• Mepolizumab
• Omalizumab
• Benralizumab
• Dupilumab

Correct Answer: Omalizumab

Q7. Common systemic adverse effects of long-term oral corticosteroid use include:

• Hypoglycemia and weight loss
• Osteoporosis, hyperglycemia, and adrenal suppression
• Hyperkalemia and nephrotoxicity
• Increased hemoglobin and leukocytosis

Correct Answer: Osteoporosis, hyperglycemia, and adrenal suppression

Q8. Which inhaler device is recommended to be used with a spacer for improved drug delivery from an MDI?

• Dry powder inhaler
• Metered-dose inhaler
• Jet nebulizer only
• Soft mist inhaler

Correct Answer: Metered-dose inhaler

Q9. Which medication should not be used as monotherapy in persistent asthma due to risk of severe exacerbations?

• Inhaled corticosteroid
• Long-acting beta-2 agonist (LABA)
• Leukotriene receptor antagonist
• Short-acting beta-2 agonist

Correct Answer: Long-acting beta-2 agonist (LABA)

Q10. Theophylline toxicity commonly presents with which adverse effects?

• Hypotension and bradycardia
• Arrhythmias and seizures
• Renal failure and hyperkalemia
• Profound sedation and respiratory depression

Correct Answer: Arrhythmias and seizures

Q11. Which physiologic test is most useful for monitoring day-to-day asthma control at home?

• Spirometry in hospital
• Peak expiratory flow rate (PEFR)
• Chest X-ray
• Pulse oximetry only

Correct Answer: Peak expiratory flow rate (PEFR)

Q12. Aspirin-exacerbated respiratory disease (AERD) is characterized by asthma, nasal polyps, and sensitivity to:

• Beta-blockers
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin
• Penicillin antibiotics
• ACE inhibitors

Correct Answer: Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin

Q13. Which marker is elevated in eosinophilic airway inflammation and can predict steroid responsiveness?

• Exhaled nitric oxide (FeNO)
• Serum procalcitonin
• Piriformis muscle enzyme
• Serum amylase

Correct Answer: Exhaled nitric oxide (FeNO)

Q14. Which drug is an inhaled anticholinergic used as an add-on in asthma management?

• Tiotropium
• Montelukast
• Salbutamol
• Budesonide

Correct Answer: Tiotropium

Q15. A patient uses salbutamol frequently and reports reduced symptom relief; this is most likely due to:

• Drug accumulation producing longer effect
• Tachyphylaxis or tolerance to beta-2 agonists
• Enhanced steroid sensitivity
• Improved airway remodeling

Correct Answer: Tachyphylaxis or tolerance to beta-2 agonists

Q16. In acute severe asthma unresponsive to initial therapy, which intravenous agent can be considered for bronchodilation?

• IV magnesium sulfate
• IV morphine
• IV hydrocortisone only
• IV aminophylline is never used

Correct Answer: IV magnesium sulfate

Q17. Which statement about inhaled corticosteroids (ICS) is TRUE?

• ICS provide immediate bronchodilation within minutes
• ICS reduce airway inflammation and exacerbation frequency
• ICS are contraindicated in children
• ICS cause severe systemic effects at low inhaled doses

Correct Answer: ICS reduce airway inflammation and exacerbation frequency

Q18. Which enzyme primarily metabolizes theophylline and is induced by smoking?

• CYP3A4
• CYP1A2
• CYP2D6
• Monoamine oxidase

Correct Answer: CYP1A2

Q19. Which clinical sign indicates life-threatening airflow obstruction?

• Normal speech and no accessory muscle use
• Silent chest with diminished breath sounds and rising PaCO2
• Isolated wheeze without breathlessness
• Mild cough relieved by SABA

Correct Answer: Silent chest with diminished breath sounds and rising PaCO2

Q20. Which leukotriene pathway drug blocks leukotriene D4 receptors specifically?

• Montelukast
• Zileuton
• Cromolyn sodium
• Prednisone

Correct Answer: Montelukast

Q21. Which drug is a 5-lipoxygenase inhibitor used in asthma therapy?

• Zileuton
• Montelukast
• Salmeterol
• Omalizumab

Correct Answer: Zileuton

Q22. Which monitoring parameter is most important when a patient is on long-term systemic corticosteroids?

• Serum potassium only
• Bone mineral density and blood glucose
• Serum amylase routinely
• Urine culture monthly

Correct Answer: Bone mineral density and blood glucose

Q23. Which of the following beta-blockers is most likely to exacerbate asthma?

• Atenolol (selective beta-1 blocker)
• Propranolol (nonselective beta-blocker)
• Nebivolol (vasodilatory beta-1 selective)
• Acebutolol (beta-1 selective with ISA)

Correct Answer: Propranolol (nonselective beta-blocker)

Q24. Which symptom pattern and objective measure best indicate poor asthma control?

• No symptoms and PEFR >80% predicted
• Nighttime awakenings and PEFR variability >20%
• Exercise tolerance unchanged with normal PEFR
• Intermittent daytime cough only

Correct Answer: Nighttime awakenings and PEFR variability >20%

Q25. Which agent is indicated for aspirin-exacerbated respiratory disease by targeting cysteinyl leukotrienes?

• Iloprost
• Montelukast
• Hydroxychloroquine
• Atropine

Correct Answer: Montelukast

Q26. Which biologic targets interleukin-5 (IL-5) to reduce eosinophil counts in severe eosinophilic asthma?

• Omalizumab
• Mepolizumab
• Dupilumab
• Rituximab

Correct Answer: Mepolizumab

Q27. For an acute asthma exacerbation in the emergency department, the first-line inhaled treatment is:

• Inhaled corticosteroid via DPI
• High-flow oxygen and nebulized short-acting beta-2 agonist
• Oral montelukast immediately
• Intravenous theophylline as first choice

Correct Answer: High-flow oxygen and nebulized short-acting beta-2 agonist

Q28. Which inhaled steroid has relatively high systemic bioavailability and greater potential for systemic effects?

• Budesonide
• Fluticasone propionate (lower systemic bioavailability)
• Beclomethasone dipropionate (prodrug with low systemic exposure)
• Systemic prednisone is inhaled steroid

Correct Answer: Budesonide

Q29. Which lab finding supports a diagnosis of allergic (IgE-mediated) asthma?

• Low serum IgE and neutrophilia
• Elevated serum IgE and positive skin prick tests to allergens
• Elevated creatinine only
• High troponin levels

Correct Answer: Elevated serum IgE and positive skin prick tests to allergens

Q30. Which of the following is a recommended counseling point for dry powder inhaler (DPI) use?

• Shake the inhaler vigorously before each puff
• Inhale forcefully and deeply to activate the device
• Use with a spacer
• Exhale through the mouthpiece after inhalation

Correct Answer: Inhale forcefully and deeply to activate the device

Q31. A significant drug interaction exists between theophylline and which of the following substances that can reduce theophylline levels?

• Ciprofloxacin
• Cimetidine
• Tobacco smoking
• Macrolide antibiotics

Correct Answer: Tobacco smoking

Q32. What is the role of cromolyn sodium in asthma therapy?

• Systemic corticosteroid for severe asthma
• Mast cell stabilizer useful for exercise-induced and allergic asthma prevention
• Long-acting bronchodilator
• First-line agent for status asthmaticus

Correct Answer: Mast cell stabilizer useful for exercise-induced and allergic asthma prevention

Q33. Which of the following best describes step-down therapy in asthma?

• Rapid discontinuation of all asthma medications once symptoms improve
• Gradual reduction of controller medication once asthma is well controlled
• Switching from inhaled to oral corticosteroids as control improves
• Adding more bronchodilators when control is achieved

Correct Answer: Gradual reduction of controller medication once asthma is well controlled

Q34. Which of these is NOT a benefit of using an inhaled delivery route for asthma medications?

• Direct delivery to airways with lower systemic exposure
• Rapid onset of bronchodilation
• Higher systemic side effects compared to oral route
• Lower required dose versus systemic administration

Correct Answer: Higher systemic side effects compared to oral route

Q35. Which emergency medication is indicated for life-threatening bronchospasm with circulatory collapse?

• Subcutaneous insulin
• Intramuscular or subcutaneous epinephrine
• Oral antihistamine only
• Topical beta-blocker

Correct Answer: Intramuscular or subcutaneous epinephrine

Q36. Which statement about leukotriene modifiers is CORRECT?

• They are fast-acting rescue medications
• Montelukast blocks cysteinyl leukotriene receptors reducing bronchoconstriction
• Zileuton is a leukotriene receptor antagonist
• They have no role in aspirin-sensitive asthma

Correct Answer: Montelukast blocks cysteinyl leukotriene receptors reducing bronchoconstriction

Q37. Which of these is an appropriate pharmacist intervention to improve inhaled steroid adherence?

• Advise stopping ICS when symptoms improve
• Demonstrate correct inhaler technique and discuss regular use even when asymptomatic
• Recommend doubling inhaled steroid dose daily without consultation
• Suggest substituting with over-the-counter antihistamines

Correct Answer: Demonstrate correct inhaler technique and discuss regular use even when asymptomatic

Q38. Which parameter on spirometry primarily indicates the degree of airflow obstruction?

• FEV1 (forced expiratory volume in 1 second)
• TLC (total lung capacity)
• DLCO (diffusing capacity for carbon monoxide)
• Resting respiratory rate

Correct Answer: FEV1 (forced expiratory volume in 1 second)

Q39. Dupilumab, used in severe type 2 asthma, targets which pathway?

• IgE neutralization
• IL-4 and IL-13 signaling via IL-4Rα blockade
• TNF-alpha inhibition
• IL-17 receptor blockade

Correct Answer: IL-4 and IL-13 signaling via IL-4Rα blockade

Q40. Which factor most increases the risk of severe exacerbation in asthma patients?

• History of previous severe exacerbation or hospitalization
• Regular use of low-dose inhaled corticosteroids
• Well-controlled asthma with no nighttime symptoms
• Young age with no comorbidities

Correct Answer: History of previous severe exacerbation or hospitalization

Q41. Which inhaler error most commonly reduces delivered dose from a metered-dose inhaler?

• Holding breath for 10 seconds after inhalation
• Coordinating actuation with inhalation poorly
• Using a spacer with the MDI
• Cleaning the mouthpiece regularly

Correct Answer: Coordinating actuation with inhalation poorly

Q42. In severe asthma with persistent eosinophilia despite high-dose ICS, which add-on is appropriate?

• Oral beta-blocker
• Anti-IL-5 therapy such as mepolizumab or benralizumab
• Increase SABA use daily
• Discontinue all inhaled medications

Correct Answer: Anti-IL-5 therapy such as mepolizumab or benralizumab

Q43. Which statement about peak expiratory flow (PEF) zones in an asthma action plan is correct?

• Green zone indicates <50% of personal best
• Yellow zone indicates 50–80% of personal best and need for action plan steps
• Red zone indicates >80% of personal best
• Zones are not individualized and use population norms only

Correct Answer: Yellow zone indicates 50–80% of personal best and need for action plan steps

Q44. Which medication class reduces airway inflammation by binding to intracellular glucocorticoid receptors?

• Beta-2 agonists
• Inhaled corticosteroids
• Anticholinergics
• Theophylline

Correct Answer: Inhaled corticosteroids

Q45. Which is an appropriate counseling point after using inhaled corticosteroid?

• Rinse mouth and spit to reduce risk of oral candidiasis
• Never use a spacer
• Do not use daily even if prescribed
• Stop if mild hoarseness develops

Correct Answer: Rinse mouth and spit to reduce risk of oral candidiasis

Q46. Which clinical trial finding supports the use of combination ICS+LABA inhalers over LABA monotherapy?

• LABA monotherapy reduces exacerbation risk more than ICS
• ICS+LABA reduces exacerbations and improves control compared with LABA alone
• ICS+LABA increases mortality compared with placebo
• Combination therapy has no benefit on symptoms

Correct Answer: ICS+LABA reduces exacerbations and improves control compared with LABA alone

Q47. In pediatrics, which controller medication is commonly used for mild persistent asthma?

• Daily low-dose inhaled corticosteroid
• Daily systemic corticosteroid maintenance
• Theophylline as first-line
• Oral beta-blocker

Correct Answer: Daily low-dose inhaled corticosteroid

Q48. Which of the following best describes exercise-induced bronchoconstriction management?

• Daily high-dose oral steroids only
• Use of short-acting beta-2 agonist 10–15 minutes before exercise and consider daily controller therapy
• Avoid all physical activity permanently
• Use of long-term antibiotics

Correct Answer: Use of short-acting beta-2 agonist 10–15 minutes before exercise and consider daily controller therapy

Q49. Which antihistamine or medication class is effective as monotherapy for controlling underlying airway inflammation in asthma?

• First-generation H1 antihistamines
• Inhaled corticosteroids
• Oral decongestants
• Topical nasal steroids only

Correct Answer: Inhaled corticosteroids

Q50. When counseling on inhaler adherence for elderly patients with arthritis limiting hand strength, which option is most appropriate?

• Recommend a dry powder inhaler requiring forceful hand actuation
• Suggest using a spacer with a metered-dose inhaler or use a soft mist inhaler
• Advise they cannot use any inhaler and stop therapy
• Recommend increasing oral steroid doses instead

Correct Answer: Suggest using a spacer with a metered-dose inhaler or use a soft mist inhaler

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