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1. COPD is characterized by all of the following, EXCEPT:

A. Being progressive B. Enhanced chronic inflammation C. Difficulty in getting air into the lungs D. Chronic bronchitis and emphysema

2. Which of the following statements is TRUE regarding the prevalence of cardiopulmonary obstructive disorder (COPD):

A. Currently the 4th leading cause of death in the United States B. Is projected to be the 3rd leading cause of death by 2020 C. Is more common in men than in women D. A & C E. A & B

3. Inflammatory cell changes occurring in COPD include in increase in all of the following, EXCEPT:

A. T lymphocytes B. Goblet cells C. Macrophages D. Neutrophils and eosinophils

4. Which of the following risk factors is considered the primary cause of 85% to 90% of COPD deaths:

A. Age B. Smoking C. Exposure to occupational dust and chemicals D. History of childhood respiratory infections

5. The typical presentation of a patient with COPD includes all of the following, EXCEPT:

A. Shortness of breath B. Chronic cough C. Abnormal sputum production D. Blue-tinged lips

6. As exacerbation is an acute event characterized by worsening of respiratory symptoms that

A. Are beyond normal day-to-day variations B. Warrant additional medication treatment C. Increase the risk of dying D. A & B E. All of the above

7. Which of the following statements is TRUE regarding spirometry testing:

A. FEV₁ is an excellent measure to direct choice of treatment for COPD B. FEV₁ does not require any correction based on gender, race, or age C. An FEV₁/FVC ratio < 0.7 after an inhaled bronchodilator is given is required for a diagnosis of COPD D. FEV₁ is the volume of air that the patient is able to expel in 1 minute

8. The greatest intervention that will positively influence the natural course of COPD is

A. Smoking cessation B. Pulmonary rehabilitation C. Regular vaccinations D. Long-term oxygen therapy

9. Pharmacological treatment for COPD focuses on all of the following, EXCEPT:

A. Reducing symptoms B. Reducing the frequency and severity of exacerbations C. Stopping disease progression D. Improving health status

10. Which of the following is a primary difference between inhalers and nebulized therapy:

A. Only generic drugs are available for nebulization B. Nebulizers require no special administration technique and less inspirational effort than other inhalers C. Nebulizers require less time for medication administration D. Only short-acting bronchodilators are available for nebulization

11. The correct technique for using an metered-dose inhaler (MDI) or dry-powder inhaler (DPI) includes all of the following, EXCEPT:

A. Inhale deeply and forcefully B. Hold breath for 10 seconds C. Breath out slowly D. Place the inhaler in the refrigerator between uses

12. Which of the following is the mainstay of treatment for COPD:

A. Bronchodilators B. Inhaled corticosteroids C. Theophylline D. Phosophodiesterase-4 inhibitors

13. Which of the following drug classes works to prevent smooth muscle contraction and reduce mucous secretion by blocking muscarinic receptors in large and medium airways:

A. Beta₂-agonist B. Anticholinergic C. Methylxanthine D. Phosphodiesterase-4 inhibitor

14. Which of the following is the drug class that works to reduce inflammation by inhibiting the breakdown of cyclic AMP:

A. Beta₂-agonist B. Anticholinergic C. Corticosteroid D. Phosphodiesterase-4 inhibitor

15. For both anticholinergic and beta2-agonist bronchodilators, which of the following is TRUE:

A. Inhaled formulations are preferred to oral formulations B. Long-acting formulations are preferred over short-acting formulations C. Combining the bronchodilators may be beneficial D. A & B E. All of the above

16. A patient in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Group B with more symptoms and a low risk of exacerbations should be treated with which of the following regimens as a first choice:

A. Long-acting anticholinergic or long-acting beta₂-agonist B. Long-acting beta₂-agonist + inhaled corticosteroid or long-acting anticholinergic C. Carbocysteine D. Short-acting anticholinergic prn or short-acting beta₂-agonist prn

17. According to the GOLD guidelines, inhaled corticosteroids should be used as first choice treatment in the following situations:

A. Patient Groups C and D (severe and very severe COPD) B. Only in combination with a bronchodilator C. As monotherapy in patients with mild COPD D. A & B E. B & C

18. Which of the following GOLD Patient Groups dictates that either a short-acting bronchodilator or a long-acting bronchodilator can be used:

A. Patient Group A B. Patient Group B C. Patient Group C D. Patient Group D

19. Which one of the following beta₂-agonist bronchodilators is available only as a nebulizer solution:

A. Albuterol B. Arformoterol C. Formoterol D. Salmeterol

20. In order to ensure appropriate therapy, pharmacists and technicians should review all of the following at each patient encounter, EXCEPT:

A. Adherence to treatment regimen B. Inhaler technique C. Insurance coverage D. Presence of side effects