Asthma Practice Questions

30 multiple-choice questions on Asthma for paramedic and EMT students, from Chapter 17 (Respiratory Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. A 9-year-old has had a dry cough for 2 months that is worse at night and after running in cold air. She never wheezes, and her cough eases after albuterol. What is most likely?

   1. A. Viral bronchiolitis
   2. B. Cough-variant asthma
   3. C. Inhaled foreign body
   4. D. Bacterial pneumonia
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   Answer: B. Cough-variant asthma

   Cough-variant asthma presents with a chronic dry cough, often at night or with exercise and cold air, without wheezing, and it responds to bronchodilators and controller treatment. Bronchiolitis affects infants. A foreign body follows a choking episode and causes focal signs. Pneumonia causes fever and illness over days, not a 2-month cough relieved by albuterol.

2. A woman at 28 weeks of pregnancy is having a moderate asthma attack with an SpO2 of 91%. How should her treatment differ from a nonpregnant adult's?

   1. A. It should not; treat her asthma fully
   2. B. Withhold albuterol to protect the fetus
   3. C. Give oxygen and hold the medications
   4. D. Use half doses of each medication
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   Answer: A. It should not; treat her asthma fully

   Uncontrolled asthma and maternal hypoxemia are far more dangerous to the fetus than standard asthma drugs, so pregnant patients get the usual oxygen, albuterol, ipratropium, and steroids. Albuterol is considered safe in pregnancy. Oxygen alone undertreats the bronchospasm. Half doses only prolong the attack.

3. A 22-year-old with asthma uses only an albuterol inhaler, 3 or 4 times a week, and has no other asthma medicine. What does current GINA guidance say about this?

   1. A. It is the preferred plan for most adults
   2. B. She should use albuterol just at bedtime
   3. C. Albuterol alone raises her risk of attacks
   4. D. Inhaled steroids are meant for COPD instead
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   Answer: C. Albuterol alone raises her risk of attacks

   GINA no longer recommends treating adults and adolescents with a short-acting reliever alone, because SABA-only treatment raises the risk of severe and fatal attacks; every patient should get an inhaled corticosteroid-containing treatment. It is not the preferred plan. Limiting albuterol to bedtime does not treat the inflammation. Inhaled steroids are the mainstay of asthma control, not only of COPD.

4. An intubated 28-year-old in status asthmaticus is ventilated at 10 breaths/min with long exhalation times. His EtCO2 is 58 mmHg, and his BP and SpO2 are stable. What should you do?

   1. A. Double the rate to bring the EtCO2 to 40
   2. B. Accept the higher CO2 and keep the slow rate
   3. C. Use larger tidal volumes to blow off CO2
   4. D. Shorten exhalation time to fit in more breaths
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   Answer: B. Accept the higher CO2 and keep the slow rate

   In severe asthma, raising the rate or volume to normalize CO2 causes air trapping, auto-PEEP, hypotension, and barotrauma. A moderately high CO2 is accepted while oxygenation and blood pressure are adequate (permissive hypercapnia). Doubling the rate, enlarging tidal volumes, or shortening exhalation all worsen trapping.

5. A 19-year-old says she has used her albuterol inhaler "about every hour" for 2 days. What does this history suggest?

   1. A. Poorly controlled, high-risk asthma
   2. B. Well-controlled asthma using the rescue inhaler
   3. C. Albuterol tolerance that makes it useless now
   4. D. A viral cold that is unrelated to asthma
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   Answer: A. Poorly controlled, high-risk asthma

   Needing a rescue inhaler every hour for days means the asthma is out of control, and heavy reliever use is a marker of risk for a severe or fatal attack. Treat her aggressively and transport. Controlled asthma needs a reliever rarely. Albuterol still works in an attack, although tolerance can blunt the response somewhat. A viral cold is a common trigger, not a separate problem.

6. A 16-year-old with exercise-induced bronchospasm asks how to prevent attacks during track practice. What is commonly advised?

   1. A. Use albuterol about 15 minutes before exercise
   2. B. Take albuterol after an hour of steady wheezing
   3. C. Take an antihistamine before practice
   4. D. Use a long-acting agonist by itself
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   Answer: A. Use albuterol about 15 minutes before exercise

   A short-acting beta agonist (or ICS-formoterol) taken 5 to 20 minutes before exercise prevents most exercise-induced bronchospasm, along with a warm-up. Waiting for an hour of wheezing delays treatment. Antihistamines do not prevent exercise-induced bronchospasm, and a long-acting beta agonist should not be used without an inhaled steroid.

7. A 23-year-old in a severe asthma attack can speak only single words. Your protocol lists peak flow measurement. What is the best approach?

   1. A. Delay treatment until three readings are done
   2. B. Skip the peak flow and start treatment
   3. C. Coach her through one forced effort first
   4. D. Measure it after intubation instead
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   Answer: B. Skip the peak flow and start treatment

   In a severe attack a forced exhalation can worsen bronchospasm and fatigue, and the reading adds little when the severity is already obvious, so treat first and measure later if she improves. Delaying treatment for three readings is unsafe. Even one forced effort can worsen a severe attack. Peak flow cannot be measured in an intubated patient.

8. A severe asthmatic has a heart rate of 136. Should this tachycardia keep you from giving albuterol?

   1. A. Yes; a heart rate over 120 rules out albuterol
   2. B. No; the rate often falls as breathing improves
   3. C. Yes; give ipratropium alone instead
   4. D. No, but cut the albuterol dose in half
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   Answer: B. No; the rate often falls as breathing improves

   In severe asthma, tachycardia reflects hypoxemia, effort, and stress, and it is a sign of severity, not a reason to withhold the main treatment. As bronchospasm eases, the heart rate often comes down. Ipratropium alone is a weaker bronchodilator. Half doses undertreat a severe attack.

9. A severe asthmatic is being treated with nebulizers when he suddenly gets worse, with sharp chest pain, absent breath sounds on the left, and falling SpO2. What should you suspect?

   1. A. Normal progression of bronchospasm
   2. B. A reaction to the ipratropium
   3. C. Mucus plugging in both main bronchi at once
   4. D. A pneumothorax from ruptured alveoli
   Show answer

   Answer: D. A pneumothorax from ruptured alveoli

   High pressures from air trapping can rupture alveoli, so sudden pain with one-sided absent breath sounds in an asthmatic suggests pneumothorax; watch for tension. Worsening bronchospasm affects both sides. Ipratropium does not cause one-sided findings. Plugging in both main bronchi would cause bilateral, not one-sided, loss of breath sounds.

10. When intubating a severe adult asthmatic, which tube choice is generally preferred?

    1. A. A small 6.0-mm tube to reduce airway trauma
    2. B. The largest tube that fits, such as 8.0 mm
    3. C. An uncuffed tube so that air can leak around it
    4. D. A nasal tube placed blindly through the nose
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    Answer: B. The largest tube that fits, such as 8.0 mm

    A large tube lowers airflow resistance, allows suctioning of thick mucus plugs, and makes bronchoscopy possible later. A small tube raises resistance and worsens air trapping. A cuffed tube is needed to deliver the pressures these patients need. Blind nasal intubation is slower, causes bleeding, and limits tube size.

11. An asthmatic has had more frequent attacks over the past month. Which history finding best explains this?

    1. A. She started using a spacer with her inhaler
    2. B. She now takes her albuterol before exercise
    3. C. She stopped taking her inhaled steroid
    4. D. She received her annual influenza vaccine
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    Answer: C. She stopped taking her inhaled steroid

    Inhaled corticosteroids control airway inflammation, and stopping them is a common cause of worsening control and more attacks. A spacer improves drug delivery. Pre-exercise albuterol prevents exercise attacks. The influenza vaccine is recommended for people with asthma and does not cause attacks.

12. A 3-year-old needs albuterol by metered-dose inhaler during a mild asthma flare at home. What is the best way to deliver it?

    1. A. A spacer with a tight-fitting face mask
    2. B. Spray it directly into the open mouth
    3. C. Have her hold her breath for 10 seconds without a spacer
    4. D. Spray it toward her nose while she sleeps
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    Answer: A. A spacer with a tight-fitting face mask

    Children under about 4 cannot coordinate an inhaler, so GINA recommends a valved spacer with a face mask, letting the child take several normal breaths per puff. Spraying into the open mouth deposits most of the drug in the throat. A young child cannot reliably hold her breath, and without a spacer delivery is poor. Spraying toward the nose delivers little drug to the lungs.

13. Which history most supports asthma rather than COPD in a 35-year-old with wheezing?

    1. A. Thirty pack-years of smoking and a daily morning cough
    2. B. Childhood allergies, normal breathing between attacks
    3. C. Slowly worsening dyspnea over many years
    4. D. Home oxygen use and frequent morning sputum
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    Answer: B. Childhood allergies, normal breathing between attacks

    Asthma usually starts young, often with allergies, and airflow returns to normal between attacks. COPD typically follows years of smoking with a chronic productive cough and steadily progressive, persistent dyspnea, sometimes needing home oxygen.

14. Early in an asthma attack, the EtCO2 is often low. What does a rising EtCO2 in a tiring asthmatic suggest?

    1. A. Hyperventilation from anxiety
    2. B. Tiring and retaining CO2
    3. C. Successful bronchodilation
    4. D. Accurate tube placement
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    Answer: B. Tiring and retaining CO2

    Early tachypnea lowers CO2. A normal or rising EtCO2 in a patient still in distress suggests fatigue and CO2 retention.

15. After a strong thunderstorm on a high-pollen day, your system gets many calls for sudden wheezing, including from people with only seasonal hay fever. What best explains this?

    1. A. Storm winds break pollen into tiny inhaled particles
    2. B. A chemical leak spread by the storm
    3. C. Falling barometric pressure narrows the small airways
    4. D. Storm stress triggers panic breathing
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    Answer: A. Storm winds break pollen into tiny inhaled particles

    In thunderstorm asthma, wind and moisture rupture pollen grains into fragments small enough to reach the lower airways, triggering mass outbreaks of bronchospasm, even in people with hay fever and no asthma diagnosis. A chemical leak is possible but does not fit the pollen and hay fever pattern. A drop in air pressure does not narrow the airways, and panic does not produce wheezing across a whole community.

16. Which history finding places an asthma patient at the highest risk of a fatal attack?

    1. A. Seasonal allergies
    2. B. Childhood eczema
    3. C. Use of an inhaler once a month
    4. D. Prior intubation for asthma
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    Answer: D. Prior intubation for asthma

    A history of intubation or ICU admission for asthma is a strong predictor of life-threatening future attacks.

17. A patient who uses an inhaled corticosteroid has white patches on her tongue and inner cheeks. What advice helps prevent this?

    1. A. Swallow the dose quickly after inhaling
    2. B. Stop the steroid inhaler for good
    3. C. Rinse the mouth and spit after each use
    4. D. Use it just when she is wheezing
    Show answer

    Answer: C. Rinse the mouth and spit after each use

    Oral thrush is a common local side effect of inhaled steroids. Using a spacer and rinsing and spitting after each dose reduce the amount of drug left in the mouth. Swallowing does not remove drug from the mouth. Stopping the controller worsens asthma control. Using a controller only when wheezing defeats its purpose of daily inflammation control.

18. Which history from an asthmatic best shows that her asthma is poorly controlled?

    1. A. Using her controller inhaler as prescribed daily
    2. B. Warming up before she exercises
    3. C. Waking with cough or wheeze most nights
    4. D. Seasonal allergies each spring
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    Answer: C. Waking with cough or wheeze most nights

    Waking at night with asthma symptoms is one of the GINA markers of poor control, along with frequent daytime symptoms, frequent reliever use, and activity limitation. Using a controller inhaler daily as prescribed is good adherence. Warming up before exercise is a sensible preventive habit. Seasonal allergies are a trigger, not a measure of control.

19. Which trigger is a common cause of exercise-induced bronchospasm?

    1. A. Drinking very cold water
    2. B. Breathing cold, dry air
    3. C. Breathing warm, humid air
    4. D. Dehydration before exercise
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    Answer: B. Breathing cold, dry air

    Rapid breathing of cold, dry air during exercise cools and dries the airways, triggering bronchospasm in susceptible people. Warm, humid air protects against it, which is why swimmers are affected less, and cold drinks and dehydration are not the trigger.

20. A 9-year-old with known asthma is wheezing and tachypneic after playing outside. Her SpO2 is 93%. What is the most appropriate first treatment?

    1. A. Nebulized albuterol
    2. B. Oral prednisone alone
    3. C. IV magnesium sulfate
    4. D. IM epinephrine
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    Answer: A. Nebulized albuterol

    An inhaled short-acting beta-2 agonist is first-line for acute bronchospasm. Escalate if the response is poor.

21. You are treating a severe asthmatic whose wheezing is getting quieter while she becomes more tired and drowsy. Which action is most appropriate?

    1. A. Document improvement and stop the nebulizer
    2. B. Assist her breathing; prepare for an advanced airway
    3. C. Have her walk to the ambulance to save time
    4. D. Give her an oral steroid and recheck her in 30 minutes
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    Answer: B. Assist her breathing; prepare for an advanced airway

    Quieter wheezing with fatigue and drowsiness means less air is moving, not improvement; she needs ventilatory support. Stopping treatment because the wheezing faded is a dangerous misreading. Exertion worsens her failing breathing. An oral steroid works over hours and cannot stop impending arrest.

22. Why is aspirin a concern in some adults with asthma?

    1. A. It blocks albuterol's effect
    2. B. It can trigger bronchospasm
    3. C. It causes direct airway edema
    4. D. It lowers oxygen saturation
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    Answer: B. It can trigger bronchospasm

    Some asthmatics, often those with nasal polyps, have aspirin-exacerbated respiratory disease and develop bronchospasm after aspirin or NSAIDs.

23. Asthma attacks are classically associated with which phase of breathing becoming prolonged?

    1. A. The apneic pause
    2. B. The inspiratory plateau
    3. C. Inspiration
    4. D. Expiration
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    Answer: D. Expiration

    Narrowed small airways collapse further during exhalation, so the expiratory phase is prolonged and wheezing is heard mainly on exhalation.

24. A 15-year-old asthmatic has an SpO2 of 92%, speaks in short phrases, and is breathing 28 times a minute. Her peak flow is 55% of her personal best. Which severity best fits?

    1. A. Severe exacerbation
    2. B. Life-threatening exacerbation
    3. C. Mild to moderate exacerbation
    4. D. Normal breathing for her
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    Answer: C. Mild to moderate exacerbation

    GINA groups attacks with phrase speech, a respiratory rate up to 30, an SpO2 of 90% to 95%, and a peak flow above 50% as mild to moderate. Severe attacks have single-word speech, accessory muscle use, a rate over 30, an SpO2 below 90%, or a peak flow of 50% or less. Life-threatening signs are drowsiness, confusion, or a silent chest. A peak flow at 55% of her best is not normal.

25. An asthmatic's peak flow is 180 L/min, and her personal best is 400 L/min. What percentage of her personal best is this?

    1. A. 55%
    2. B. 22%
    3. C. 72%
    4. D. 45%
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    Answer: D. 45%

    Divide today's value by the personal best: 180 / 400 = 0.45, or 45%. A value at or below 50% indicates a severe exacerbation. 55% is the shortfall from her best, not the percentage achieved. 22% and 72% do not follow from the numbers.

26. What is the most common trigger of asthma attacks in school-age children?

    1. A. Strenuous exercise in cold air
    2. B. Viral respiratory infections
    3. C. Food additives such as sulfites
    4. D. Seasonal pollen allergies
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    Answer: B. Viral respiratory infections

    Viral infections, especially rhinovirus colds, trigger most asthma exacerbations in school-age children, which is why attacks peak after school starts in the fall. Exercise in cold air can trigger bronchospasm, but it causes fewer severe attacks. Sulfite food additives trigger attacks in only a small minority of asthmatics. Seasonal pollen allergies worsen asthma in some children but cause fewer exacerbations than viral colds.

27. A 25-year-old asthmatic is on 'controller' medications. Which inhaler should she use during an acute attack?

    1. A. Her long-acting beta agonist only
    2. B. Her inhaled corticosteroid
    3. C. Her short-acting beta agonist
    4. D. Her leukotriene modifier
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    Answer: C. Her short-acting beta agonist

    Rescue inhalers such as albuterol act quickly. Inhaled steroids and leukotriene modifiers are controllers that do not relieve acute bronchospasm.

28. Which feature of the expiratory capnogram may show improvement after bronchodilator therapy?

    1. A. It drops abruptly to zero
    2. B. It becomes more square
    3. C. It flattens into a line
    4. D. Its baseline rises above zero
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    Answer: B. It becomes more square

    As obstruction eases, exhaled CO2 rises more quickly and the waveform changes from a 'shark fin' toward a normal square shape.

29. CPAP may be considered in an alert, cooperative asthmatic who is in respiratory distress. Which finding would make CPAP inappropriate?

    1. A. Inability to protect the airway
    2. B. Respiratory rate of 28 breaths/min
    3. C. Audible expiratory wheezing
    4. D. SpO2 of 91% on supplemental oxygen
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    Answer: A. Inability to protect the airway

    CPAP requires an alert patient who can protect the airway and breathe on his or her own. Altered mental status or inability to protect the airway is a contraindication.

30. A peak flow reading below what fraction of the patient's personal best suggests a severe asthma exacerbation?

    1. A. 90%
    2. B. 75%
    3. C. 50%
    4. D. 80%
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    Answer: C. 50%

    A peak flow under 50% of predicted or personal best indicates a severe exacerbation that requires aggressive treatment.