MCQs on Asthma & COPD

Written by Dr. Daniel Fraser (MBBS, FRACP) – Physician

Question 1

A 12-year-old boy is brought to the emergency department by his mother with complaints of cough and wheezing. He has had previous episodes in the past, and has not had any specific treatment so far. On examination, he has a respiratory rate of 40 breaths per minute and a temperature of 37.5°C. On chest auscultation, widespread wheeze is noted bilaterally. The rest of the exam is inconclusive. Which one of the following is most likely to make a diagnosis now and in the emergency setting?

A) CT scan of the chest.
B) Chest X-ray (CXR).
C) Spirometry.
D) Improvement with salbutamol.
E) Measurement of peak expiratory flow (PEF).

Correct Answer: D) Improvement with salbutamol.

This clinical scenario is highly suggestive of an acute asthma exacerbation in a previously undiagnosed child. Asthma is characterized by reversible bronchial obstruction, and a prompt improvement after administration of a bronchodilator like salbutamol is a hallmark feature confirming the diagnosis in an emergency setting.

(Option A) CT scan of the chest is not routinely used to diagnose asthma and is reserved for atypical presentations or complications.
(Option B) Chest X-ray may help exclude alternative diagnoses such as pneumonia or foreign body but is not diagnostic for asthma.
(Option C) Spirometry is not practical during an acute episode due to the difficulty in performing forced maneuvers in a distressed child.
(Option E) Peak expiratory flow (PEF) is useful for monitoring treatment response, but it is less helpful for initial diagnosis, especially in an emergency situation.

Therefore, in an emergency setting, the diagnostic response to salbutamol is the most reliable and practical indicator of asthma.

Question 2

A 6-year-old boy is brought to your attention because of frequent episodes of wheezing and cough at night and during exercise. You prescribe salbutamol on as-needed basis and regular low-dose inhaled fluticasone. Which one of the following medications is most effective in preventing further episodes?

A) Long-acting beta agonists (LABA).
B) Short-acting beta agonists (SABA).
C) Sodium cromoglycate (SCG).
D) Fluticasone.
E) Montelukast.

Correct Answer: D) Fluticasone.

This child has persistent asthma, as indicated by frequent night-time symptoms and exercise-induced wheezing. In such cases, the most effective preventive therapy is a regular low-dose inhaled corticosteroid (ICS) such as fluticasone.

ICSs are the first-line maintenance treatment in children with persistent asthma and are proven to reduce symptoms, improve lung function, and prevent exacerbations. In Australia, ICSs are commonly referred to as “preventers” and are considered the cornerstone of asthma management in children with persistent symptoms.

(Option A) LABAs are not used as monotherapy and are typically added to ICS if control is not achieved.
(Option B) SABAs like salbutamol are used for symptom relief, not as a preventive therapy.
(Option C) Sodium cromoglycate may be used as an alternative but is less effective than ICS and requires frequent dosing with more effort to maintain proper device function.
(Option E) Montelukast can be trialed, especially to avoid steroid use, but it is less effective than ICS and is generally not the first-line preventive agent.

Thus, fluticasone remains the most effective choice for preventing further episodes in this child with persistent asthma.

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3. Respiratory Module

3.1 Asthma & COPD

3.2 Pulmonary Vascular Diseases

3.3 Pleural Diseases

3.4 Lung Cancer

3.5 Other Lung Diseases