NURS 621 Assignment 7.1 Version 3: Comprehensive
Asthma Management – Integrating 2026 GINA Guidelines
for Diagnosis, Personalized Pharmacotherapy, Biologic
Sequencing, Adherence Optimization, Comorbidity
Management, and Reducing Health Inequities in Asthma
Care
Section 1: Diagnosis and Initial Assessment (Questions 1–15)
1. A 28-year-old female presents with episodic cough, chest tightness, and wheezing
triggered by cold air and exercise. Spirometry is normal. What is the most appropriate next
step?
✅ A) Bronchoprovocation challenge with methacholine – Detects airway hyperresponsiveness
when baseline spirometry is normal
B) High-resolution CT chest – Not indicated without suspicion of bronchiectasis or interstitial
disease
C) Empiric course of oral steroids – Inappropriate without confirmed diagnosis
D) Allergy skin testing – Identifies atopy but does not confirm asthma
2. A 45-year-old patient on daily ICS has normal spirometry and reports good control. How
can you assess for residual airway hyperresponsiveness?
✅ A) Withhold ICS for 2–4 weeks and repeat spirometry – Reveals masked reversibility
B) Increase ICS dose – Will not unmask underlying variability
C) Methacholine challenge while on ICS – May be falsely negative
D) Check FeNO only – May be normal despite AHR
3. Which finding on serial peak expiratory flow (PEF) monitoring is diagnostic of asthma?
✅ A) Diurnal variability >10% on ≥2 days over 14 days – GINA 2026 diagnostic criterion
B) Single low reading – Insufficient
C) Consistent readings within 5% – Normal
D) Higher readings in the morning – Paradoxical; asthma typically worse in morning
,4. A 55-year-old smoker with dyspnea and wheezing. Which test best distinguishes asthma
from COPD?
✅ A) DLCO (diffusing capacity for carbon monoxide) – Normal in asthma, reduced in COPD
✅ B) FeNO ≥50 ppb – Suggests eosinophilic (asthma) phenotype
C) Spirometry alone – Overlap is common
D) Chest X-ray – Not diagnostic
5. Fractional exhaled nitric oxide (FeNO) level that indicates type 2 inflammation in an adult
not on ICS is?
✅ A) ≥50 ppb – *ATS/ERS threshold for high type 2*
B) 25–49 ppb – Intermediate
C) <25 ppb – Low type 2
D) Any elevation – Not specific
6. A 16-year-old athlete reports cough and chest tightness after soccer practice. Resting
spirometry is normal. What is the diagnostic test of choice?
✅ A) Exercise challenge with FEV1 measured pre- and post-exercise – Fall ≥10% confirms EIB
B) Methacholine challenge – May be positive but less specific to exercise
C) Peak flow diary at home – Less accurate than laboratory challenge
D) Empiric albuterol before exercise – Treatment, not diagnosis
7. Methacholine challenge is considered negative (essentially ruling out asthma) at which
PC20 threshold?
✅ A) >16 mg/mL – High negative predictive value
B) ≤8 mg/mL – Positive
C) 9–16 mg/mL – Borderline
D) Any fall in FEV1 – Not specific
8. Which differential diagnosis should be considered in a patient with episodic dyspnea and
normal FeNO? (Select 2)
✅ A) Vocal cord dysfunction – Inspiratory stridor, normal FeNO
✅ B) Heart failure with preserved ejection fraction – Cardiac wheeze
C) Eosinophilic asthma – Typically elevated FeNO
D) Allergic bronchopulmonary aspergillosis – Elevated IgE and eosinophils
9. A 34-year-old female has a flow-volume loop showing a flattened inspiratory limb. This is
characteristic of?
, ✅ A) Vocal cord dysfunction – Classic finding
B) Asthma – Expiratory flow limitation
C) Fixed upper airway obstruction – Flattened inspiratory and expiratory
D) COPD – Expiratory, not inspiratory
10. Impulse oscillometry (IOS) is particularly advantageous for which population?
✅ A) Young children unable to perform forced spirometry – Requires tidal breathing only
B) Adults with classic asthma – Spirometry remains first-line
C) Acute exacerbation – Not validated
D) Routine screening – Not cost-effective
11. Blood eosinophil level that defines eosinophilic asthma and makes biologic therapy more
likely to benefit?
✅ A) ≥150 cells/μL – *GINA 2026 threshold for considering anti-IL5*
B) ≥300 cells/μL – Higher likelihood of response
C) ≥500 cells/μL – Very high, still responsive
D) <100 cells/μL – Non-eosinophilic
12. A patient with suspected asthma has a methacholine PC20 of 10 mg/mL. How should you
interpret this?
✅ A) Borderline; clinical correlation needed – Equivocal result
B) Positive for asthma – *Only if ≤8 mg/mL*
C) Negative – *Only if >16 mg/mL*
D) Diagnostic of COPD – No
13. Which chest CT finding is characteristic of allergic bronchopulmonary aspergillosis
(ABPA)?
✅ A) Central bronchiectasis – Hallmark radiologic finding
B) Peripheral tree-in-bud nodules – Suggests infection
C) Ground glass opacities – Non-specific
D) Normal CT – Does not exclude ABPA
14. A patient with asthma, nasal polyps, and hives after taking ibuprofen likely has?
✅ A) Aspirin-exacerbated respiratory disease (AERD, Samter's triad) – Classic triad
B) Allergic asthma – No NSAID reaction
C) Vocal cord dysfunction – No polyp or drug reaction
D) COPD – No
Asthma Management – Integrating 2026 GINA Guidelines
for Diagnosis, Personalized Pharmacotherapy, Biologic
Sequencing, Adherence Optimization, Comorbidity
Management, and Reducing Health Inequities in Asthma
Care
Section 1: Diagnosis and Initial Assessment (Questions 1–15)
1. A 28-year-old female presents with episodic cough, chest tightness, and wheezing
triggered by cold air and exercise. Spirometry is normal. What is the most appropriate next
step?
✅ A) Bronchoprovocation challenge with methacholine – Detects airway hyperresponsiveness
when baseline spirometry is normal
B) High-resolution CT chest – Not indicated without suspicion of bronchiectasis or interstitial
disease
C) Empiric course of oral steroids – Inappropriate without confirmed diagnosis
D) Allergy skin testing – Identifies atopy but does not confirm asthma
2. A 45-year-old patient on daily ICS has normal spirometry and reports good control. How
can you assess for residual airway hyperresponsiveness?
✅ A) Withhold ICS for 2–4 weeks and repeat spirometry – Reveals masked reversibility
B) Increase ICS dose – Will not unmask underlying variability
C) Methacholine challenge while on ICS – May be falsely negative
D) Check FeNO only – May be normal despite AHR
3. Which finding on serial peak expiratory flow (PEF) monitoring is diagnostic of asthma?
✅ A) Diurnal variability >10% on ≥2 days over 14 days – GINA 2026 diagnostic criterion
B) Single low reading – Insufficient
C) Consistent readings within 5% – Normal
D) Higher readings in the morning – Paradoxical; asthma typically worse in morning
,4. A 55-year-old smoker with dyspnea and wheezing. Which test best distinguishes asthma
from COPD?
✅ A) DLCO (diffusing capacity for carbon monoxide) – Normal in asthma, reduced in COPD
✅ B) FeNO ≥50 ppb – Suggests eosinophilic (asthma) phenotype
C) Spirometry alone – Overlap is common
D) Chest X-ray – Not diagnostic
5. Fractional exhaled nitric oxide (FeNO) level that indicates type 2 inflammation in an adult
not on ICS is?
✅ A) ≥50 ppb – *ATS/ERS threshold for high type 2*
B) 25–49 ppb – Intermediate
C) <25 ppb – Low type 2
D) Any elevation – Not specific
6. A 16-year-old athlete reports cough and chest tightness after soccer practice. Resting
spirometry is normal. What is the diagnostic test of choice?
✅ A) Exercise challenge with FEV1 measured pre- and post-exercise – Fall ≥10% confirms EIB
B) Methacholine challenge – May be positive but less specific to exercise
C) Peak flow diary at home – Less accurate than laboratory challenge
D) Empiric albuterol before exercise – Treatment, not diagnosis
7. Methacholine challenge is considered negative (essentially ruling out asthma) at which
PC20 threshold?
✅ A) >16 mg/mL – High negative predictive value
B) ≤8 mg/mL – Positive
C) 9–16 mg/mL – Borderline
D) Any fall in FEV1 – Not specific
8. Which differential diagnosis should be considered in a patient with episodic dyspnea and
normal FeNO? (Select 2)
✅ A) Vocal cord dysfunction – Inspiratory stridor, normal FeNO
✅ B) Heart failure with preserved ejection fraction – Cardiac wheeze
C) Eosinophilic asthma – Typically elevated FeNO
D) Allergic bronchopulmonary aspergillosis – Elevated IgE and eosinophils
9. A 34-year-old female has a flow-volume loop showing a flattened inspiratory limb. This is
characteristic of?
, ✅ A) Vocal cord dysfunction – Classic finding
B) Asthma – Expiratory flow limitation
C) Fixed upper airway obstruction – Flattened inspiratory and expiratory
D) COPD – Expiratory, not inspiratory
10. Impulse oscillometry (IOS) is particularly advantageous for which population?
✅ A) Young children unable to perform forced spirometry – Requires tidal breathing only
B) Adults with classic asthma – Spirometry remains first-line
C) Acute exacerbation – Not validated
D) Routine screening – Not cost-effective
11. Blood eosinophil level that defines eosinophilic asthma and makes biologic therapy more
likely to benefit?
✅ A) ≥150 cells/μL – *GINA 2026 threshold for considering anti-IL5*
B) ≥300 cells/μL – Higher likelihood of response
C) ≥500 cells/μL – Very high, still responsive
D) <100 cells/μL – Non-eosinophilic
12. A patient with suspected asthma has a methacholine PC20 of 10 mg/mL. How should you
interpret this?
✅ A) Borderline; clinical correlation needed – Equivocal result
B) Positive for asthma – *Only if ≤8 mg/mL*
C) Negative – *Only if >16 mg/mL*
D) Diagnostic of COPD – No
13. Which chest CT finding is characteristic of allergic bronchopulmonary aspergillosis
(ABPA)?
✅ A) Central bronchiectasis – Hallmark radiologic finding
B) Peripheral tree-in-bud nodules – Suggests infection
C) Ground glass opacities – Non-specific
D) Normal CT – Does not exclude ABPA
14. A patient with asthma, nasal polyps, and hives after taking ibuprofen likely has?
✅ A) Aspirin-exacerbated respiratory disease (AERD, Samter's triad) – Classic triad
B) Allergic asthma – No NSAID reaction
C) Vocal cord dysfunction – No polyp or drug reaction
D) COPD – No
