Chronic obstructive airway disease (COPD) MCQs With Answer

Introduction: Chronic obstructive airway disease (COPD) MCQs with Answer are essential study tools for B. Pharm students preparing for pharmacology and therapeutics exams. This focused resource explains COPD pathophysiology, risk factors, spirometry diagnosis, GOLD classification, pharmacotherapy (inhaled bronchodilators, corticosteroids, PDE4 inhibitors), exacerbation management, and nonpharmacologic care like smoking cessation and pulmonary rehabilitation. Emphasis on drug mechanisms, dosing, inhaler devices, adverse effects, and drug interactions helps pharmacy students apply clinical reasoning and improve patient outcomes. Practicing targeted MCQs enhances retention, exam readiness, and prescription counseling skills. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the primary diagnostic test to confirm COPD?

• Chest X-ray
• Computed tomography (CT) scan
• Spirometry with post-bronchodilator FEV1/FVC ratio
• Pulse oximetry

Correct Answer: Spirometry with post-bronchodilator FEV1/FVC ratio

Q2. Which value defines airflow limitation in COPD after bronchodilator?

• FEV1/FVC ratio <0.70
• FEV1/FVC ratio >0.80
• FEV1 increase ≥15%
• FVC decrease >20%

Correct Answer: FEV1/FVC ratio <0.70

Q3. The most common risk factor for COPD worldwide is:

• Occupational dust exposure
• Alpha-1 antitrypsin deficiency
• Tobacco smoking
• Outdoor air pollution

Correct Answer: Tobacco smoking

Q4. Which pathological change is characteristic of COPD?

• Reversible bronchial hyperreactivity only
• Alveolar wall destruction leading to emphysema
• Primary interstitial fibrosis
• Pulmonary vascular occlusion

Correct Answer: Alveolar wall destruction leading to emphysema

Q5. Which class of drug is considered first-line for symptomatic relief in COPD?

• Inhaled corticosteroids (ICS)
• Long-acting bronchodilators (LABA or LAMA)
• Oral antibiotics
• Systemic immunosuppressants

Correct Answer: Long-acting bronchodilators (LABA or LAMA)

Q6. Tiotropium is classified as which type of bronchodilator?

• Short-acting beta-2 agonist
• Long-acting muscarinic antagonist (LAMA)
• Inhaled corticosteroid
• Phosphodiesterase-4 inhibitor

Correct Answer: Long-acting muscarinic antagonist (LAMA)

Q7. Which inhaler device requires coordination of actuation and inhalation?

• Dry powder inhaler (DPI)
• Metered-dose inhaler (MDI)
• Soft mist inhaler (SMI)
• Nebulizer

Correct Answer: Metered-dose inhaler (MDI)

Q8. Which combination is recommended for COPD patients with persistent symptoms despite single long-acting bronchodilator?

• LABA + LAMA
• LABA + ICS
• LAMA + oral steroid
• ICS + oral antibiotic

Correct Answer: LABA + LAMA

Q9. In COPD exacerbation, the most common bacterial pathogens include:

• Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
• Mycobacterium tuberculosis and Pseudomonas aeruginosa only
• Staphylococcus aureus exclusively
• Viral pathogens only

Correct Answer: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis

Q10. Roflumilast acts by inhibiting which enzyme?

• Cyclooxygenase-2 (COX-2)
• Phosphodiesterase-4 (PDE4)
• Acetylcholinesterase
• Monoamine oxidase

Correct Answer: Phosphodiesterase-4 (PDE4)

Q11. Which therapy is proven to reduce mortality in selected COPD patients with chronic respiratory failure?

• Long-term oxygen therapy (LTOT)
• Short-acting bronchodilator PRN
• Intermittent systemic steroids
• Oral theophylline only

Correct Answer: Long-term oxygen therapy (LTOT)

Q12. Which adverse effect is commonly associated with inhaled corticosteroids in COPD?

• Systemic Cushing’s syndrome
• Oral candidiasis and dysphonia
• Severe hypoglycemia
• Bradycardia

Correct Answer: Oral candidiasis and dysphonia

Q13. The GOLD classification of COPD primarily uses which parameters?

• Chest X-ray findings only
• FEV1 percent predicted and symptom/exacerbation assessment
• Blood eosinophil count exclusively
• Age and BMI

Correct Answer: FEV1 percent predicted and symptom/exacerbation assessment

Q14. Which marker can help predict response to inhaled corticosteroids in COPD?

• Blood eosinophil count
• Serum creatinine
• Arterial CO2 tension only
• Chest circumference

Correct Answer: Blood eosinophil count

Q15. Which short-acting bronchodilator is commonly used for acute relief in COPD?

• Salbutamol (albuterol)
• Salmeterol
• Tiotropium
• Roflumilast

Correct Answer: Salbutamol (albuterol)

Q16. Theophylline exerts bronchodilator effects primarily by:

• Blocking beta-2 receptors
• Inhibiting phosphodiesterase, increasing cAMP
• Stimulating muscarinic receptors
• Antagonizing leukotriene receptors

Correct Answer: Inhibiting phosphodiesterase, increasing cAMP

Q17. In COPD pharmacotherapy, combining ICS with LABA is particularly useful for patients with:

• High blood eosinophils and frequent exacerbations
• Pure emphysema without exacerbations
• Only smoking history but no symptoms
• Acute respiratory failure requiring intubation

Correct Answer: High blood eosinophils and frequent exacerbations

Q18. Which inhaled bronchodilator class can increase heart rate and tremor as side effects?

• Long-acting muscarinic antagonists (LAMA)
• Beta-2 agonists (short- or long-acting)
• Inhaled corticosteroids
• Phosphodiesterase inhibitors

Correct Answer: Beta-2 agonists (short- or long-acting)

Q19. Which measure is essential for proper delivery when using a dry powder inhaler (DPI)?

• Slow, gentle inhalation
• Rapid, forceful inhalation
• Actuation during exhalation
• Shaking the inhaler vigorously

Correct Answer: Rapid, forceful inhalation

Q20. Which vaccine is recommended to reduce respiratory infections in COPD patients?

• BCG vaccine
• Influenza and pneumococcal vaccines
• Varicella vaccine
• HPV vaccine

Correct Answer: Influenza and pneumococcal vaccines

Q21. Long-acting beta-2 agonists (LABAs) provide bronchodilation by:

• Blocking acetylcholine receptors
• Stimulating beta-2 adrenergic receptors to increase cAMP
• Inhibiting leukotriene synthesis
• Activating GABA receptors

Correct Answer: Stimulating beta-2 adrenergic receptors to increase cAMP

Q22. Which drug is an inhaled corticosteroid commonly used in COPD combinations?

• Budesonide
• Tiotropium
• Albuterol
• Roflumilast

Correct Answer: Budesonide

Q23. In acute severe COPD exacerbation, first-line immediate therapy includes:

• Systemic corticosteroids and short-acting bronchodilators
• Long-term oxygen therapy only
• Immediate roflumilast and theophylline
• Oral antifungals

Correct Answer: Systemic corticosteroids and short-acting bronchodilators

Q24. What is the role of azithromycin in COPD management?

• Chronically reduces exacerbation frequency in selected patients
• Primary bronchodilator for symptom relief
• First-line treatment for all COPD patients
• Used to increase FEV1 in stable COPD

Correct Answer: Chronically reduces exacerbation frequency in selected patients

Q25. Which physiological change is typical in emphysematous COPD?

• Increased elastic recoil of lungs
• Loss of alveolar surface area and decreased gas exchange
• Predominant airflow obstruction reversible with bronchodilators
• Primary upper airway obstruction

Correct Answer: Loss of alveolar surface area and decreased gas exchange

Q26. Which parameter is monitored to assess chronic oxygen therapy effectiveness?

• Fasting blood glucose
• PaO2 and SpO2 levels
• Serum potassium
• Chest wall circumference

Correct Answer: PaO2 and SpO2 levels

Q27. Which patient factor increases risk of COPD due to genetic deficiency?

• Alpha-1 antitrypsin deficiency
• Excess vitamin D
• High HDL cholesterol
• Low BMI only

Correct Answer: Alpha-1 antitrypsin deficiency

Q28. Which inhaled therapy is associated with increased risk of pneumonia in COPD trials?

• Inhaled corticosteroids
• Long-acting muscarinic antagonists
• Short-acting beta-2 agonists
• Roflumilast

Correct Answer: Inhaled corticosteroids

Q29. Which monitoring is important for patients on long-term systemic corticosteroids?

• Bone density and glucose monitoring
• Hearing tests
• Daily liver biopsy
• Routine ECG for QT prolongation only

Correct Answer: Bone density and glucose monitoring

Q30. Which drug class should be used cautiously with anticholinergic bronchodilators due to additive anticholinergic effects?

• Beta blockers
• Tricyclic antidepressants and antihistamines
• Inhaled corticosteroids
• Macrolide antibiotics

Correct Answer: Tricyclic antidepressants and antihistamines

Q31. Smoking cessation pharmacotherapy options include:

• NRT (nicotine replacement therapy), varenicline, bupropion
• Long-acting bronchodilators only
• Systemic steroids
• Only counseling without drugs

Correct Answer: NRT (nicotine replacement therapy), varenicline, bupropion

Q32. Which physiologic test differentiates COPD from asthma by assessing reversibility?

• Post-bronchodilator spirometry showing minimal reversibility in COPD
• Chest ultrasound
• Arterial blood gas during sleep
• Peak expiratory flow variability only

Correct Answer: Post-bronchodilator spirometry showing minimal reversibility in COPD

Q33. Which adverse effect is commonly associated with systemic theophylline toxicity?

• Hypotension only
• Nausea, vomiting, arrhythmias, and seizures
• Severe bradycardia exclusively
• Renal failure

Correct Answer: Nausea, vomiting, arrhythmias, and seizures

Q34. For inhaler counseling, how long should a patient wait between puffs of a bronchodilator inhaler?

• No wait is necessary
• Approximately 30–60 seconds for same-inhaler bronchodilator puffs
• At least 24 hours
• Several weeks

Correct Answer: Approximately 30–60 seconds for same-inhaler bronchodilator puffs

Q35. In COPD patients with frequent exacerbations and chronic bronchitis phenotype, which oral agent may be considered?

• Roflumilast
• Oral prednisone indefinitely
• High-dose oral theophylline routinely
• Long-term oral antibiotics in all patients

Correct Answer: Roflumilast

Q36. Which inhaled bronchodilator is most appropriate for maintenance once-daily dosing?

• Salbutamol inhaler twice daily
• Tiotropium once daily
• Short-acting ipratropium every 4 hours
• Oral albuterol daily

Correct Answer: Tiotropium once daily

Q37. Which electrolyte disturbance can be precipitated by beta-2 agonists?

• Hyperkalemia
• Hypokalemia
• Hypercalcemia
• Hyponatremia

Correct Answer: Hypokalemia

Q38. Pulmonary rehabilitation benefits in COPD include:

• Improved exercise tolerance and quality of life
• Guaranteed improvement in FEV1 above normal
• Immediate cure of emphysema
• Complete elimination of exacerbations

Correct Answer: Improved exercise tolerance and quality of life

Q39. Which pharmacokinetic factor is important for systemic absorption from inhaled corticosteroids?

• Particle size and lung deposition
• Renal clearance only
• Gastrointestinal motility exclusively
• Serum albumin binding solely

Correct Answer: Particle size and lung deposition

Q40. Which drug interaction is relevant when prescribing theophylline?

• Cimetidine and ciprofloxacin can increase theophylline levels
• Antacids greatly increase clearance
• Statins double theophylline clearance
• Vitamin C prevents theophylline toxicity

Correct Answer: Cimetidine and ciprofloxacin can increase theophylline levels

Q41. Which clinical sign suggests CO2 retention in advanced COPD?

• Hyperventilation with respiratory alkalosis
• Morning headache and daytime somnolence
• Excessive sweating only
• Brisk deep tendon reflexes

Correct Answer: Morning headache and daytime somnolence

Q42. When selecting inhaled therapy, which consideration is crucial for elderly patients?

• Ability to use device correctly and comorbidities
• Only cost of medication regardless of technique
• Prescribing maximum number of inhalers
• Avoiding all bronchodilators

Correct Answer: Ability to use device correctly and comorbidities

Q43. Which outcome measure is commonly used in COPD clinical trials to assess symptoms?

• Modified Medical Research Council (mMRC) dyspnea scale
• Glomerular filtration rate
• HIV viral load
• Hepatic transaminases

Correct Answer: Modified Medical Research Council (mMRC) dyspnea scale

Q44. Which inhaled medication class reduces mucus secretion by blocking cholinergic tone?

• B2 agonists
• Muscarinic antagonists (anticholinergics)
• Inhaled corticosteroids
• PDE4 inhibitors

Correct Answer: Muscarinic antagonists (anticholinergics)

Q45. In COPD exacerbation admitting criteria, which finding warrants hospitalization?

• Mild dyspnea with normal daily activities
• Severe increased dyspnea, hypoxemia, or hypercapnia
• No change in sputum color
• Well-controlled symptoms on home therapy

Correct Answer: Severe increased dyspnea, hypoxemia, or hypercapnia

Q46. Which laboratory marker can guide antibiotic use during COPD exacerbations?

• C-reactive protein (CRP) and procalcitonin trends may help
• Serum sodium only
• Fasting lipid profile
• Urine ketones exclusively

Correct Answer: C-reactive protein (CRP) and procalcitonin trends may help

Q47. Which is an advantage of combination inhalers (LABA+ICS or LABA+LAMA)?

• Reduced inhaler adherence
• Improved symptom control and simplified regimen
• Guaranteed avoidance of side effects
• They eliminate need for vaccinations

Correct Answer: Improved symptom control and simplified regimen

Q48. Which symptom is more typical of chronic bronchitis phenotype?

• Progressive dyspnea without sputum
• Chronic productive cough with sputum production
• Hemoptysis as primary symptom
• Sudden chest pain without cough

Correct Answer: Chronic productive cough with sputum production

Q49. For inhaler education, which step reduces oral thrush risk when using inhaled corticosteroids?

• Rinse mouth and spit after inhalation
• Take steroid tablet instead
• Avoid using any spacer
• Use higher ICS doses without rinsing

Correct Answer: Rinse mouth and spit after inhalation

Q50. In COPD therapy escalation, which approach is recommended when frequent exacerbations persist despite optimized bronchodilation?

• Add inhaled corticosteroid if eosinophils or consider roflumilast/macrolide in specific phenotypes

Correct Answer: Add inhaled corticosteroid if eosinophils or consider roflumilast/macrolide in specific phenotypes

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