Question

A 28-year-old man has a history of severe allergic asthma that is currently uncontrolled on mometasone/formoterol MDI 100/5 mcg 2 puffs twice daily plus short-acting β2-agonist (SABA) as needed for shortness of breath. The patient’s PDC is 90%. You ask him to demonstrate his inhaler technique in the office. He removes the cap from the device, places the inhaler in his mouth, and forms a tight seal with his lips. He then actuates the device and counts to 10 before removing the inhaler from his mouth. Which one of the following best evaluates this patient’s inhaler technique? PSAP 2023 Book 3 • Pulmonary and Gastrointestinal Diseases 25 Severe Asthma A. He has adequate technique and is likely experiencing symptoms from steroid-resistant type 2 inflammation. B. He has poor technique. He did not exhale before placing the inhaler in his mouth and did not coordinate his inhalation with actuation of the device. C. He has adequate technique and a non-biologic therapy should be added to his regimen. D. He has poor technique. He did not exhale before placing the inhaler in his mouth.

          A 28-year-old man has a history of severe allergic asthma that is currently uncontrolled on mometasone/formoterol MDI 100/5 mcg 2 puffs twice daily plus short-acting β2-agonist (SABA) as needed for shortness of breath. The patient’s PDC is 90%. You ask him to demonstrate his inhaler technique in the office. He removes the cap from the device, places the inhaler in his mouth, and forms a tight seal with his lips. He then actuates the device and counts to 10 before removing the inhaler from his mouth. Which one of the following best evaluates this patient’s inhaler technique?
PSAP 2023 Book 3 • Pulmonary and Gastrointestinal Diseases 25
Severe Asthma
A. 
He has adequate technique and is likely experiencing symptoms from steroid-resistant type 2 inflammation.
B. 
He has poor technique. He did not exhale before placing the inhaler in his mouth and did not coordinate his inhalation with actuation of the device.
C. 
He has adequate technique and a non-biologic therapy should be added to his regimen.
D. 
He has poor technique. He did not exhale before placing the inhaler in his mouth.

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Added by Frederick A.

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Solved by Expert Bryan Valdivia

05/09/2023

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Step 1: The patient removes the cap from the inhaler, places it in his mouth, forms a tight seal with his lips, actuates the device, and counts to 10 before removing the inhaler from his mouth. Show more…

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A 28-year-old man has a history of severe allergic asthma that is currently uncontrolled on mometasone/formoterol MDI 100/5 mcg 2 puffs twice daily plus short-acting β2-agonist (SABA) as needed for shortness of breath. The patient’s PDC is 90%. You ask him to demonstrate his inhaler technique in the office. He removes the cap from the device, places the inhaler in his mouth, and forms a tight seal with his lips. He then actuates the device and counts to 10 before removing the inhaler from his mouth. Which one of the following best evaluates this patient’s inhaler technique? PSAP 2023 Book 3 • Pulmonary and Gastrointestinal Diseases 25 Severe Asthma A. He has adequate technique and is likely experiencing symptoms from steroid-resistant type 2 inflammation. B. He has poor technique. He did not exhale before placing the inhaler in his mouth and did not coordinate his inhalation with actuation of the device. C. He has adequate technique and a non-biologic therapy should be added to his regimen. D. He has poor technique. He did not exhale before placing the inhaler in his mouth.

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00:01 Okay, this question says you have a patient with asthma.

00:04 She has been controlled until recently when her allergies have been exacerbated by the old pollen in the air.

00:10 You check her, or you check an fev that is, or a f1 that is for forced respiratory volume on her, and it says, is this an obstructive or a restrictive disease? so in this case, this patient has asthma, and asthma is generally considered an obstructive lung disease.

00:32 Okay, so it is an obstructive lung condition.

00:40 Okay, because of the hyperactivity of the airways, also the excessive mucus production, so this is practically, it follows an obstructive pattern.

00:49 Because in general, you're going to have narrowing of the airways and difficulty in breathing out.

00:55 So this is characteristic of obstructive conditions.

00:58 Now for the second question, it says, would you expect the fev1 to be lower or higher than when her asthma is controlled? so when your asthma is uncontrolled, the airways become narrowed due to the inflammation and mucus buildup, which can reduce the amount of air that can be breathed out forcefully in one second.

01:20 So practically, in this case, the fev1 is going to be decreased.

01:29 Okay, because this forced expiratory volume 1, it states for the forced expiratory volume in the first second.

01:38 So you're going to exhale forcefully all of the air that you have in your lungs.

01:44 In the first second, you have a certain amount of volume of air, and you have to divide this by the total amount of volume of air that you have exhaled, and you're going to get a ratio.

01:56 And that ratio is this value here.

02:00 In patients with obstructive conditions, this value is going to be decreased because in the first second, you're going to move out less air than normal.

02:09 And why? well, because when you're exhaling forcefully, the airways are going to narrow forcefully or suddenly, and they are going to close.

02:17 So if they close, you're not going to be able to breathe out.

02:21 So this is why you have to exhale slowly in order for your airways not to narrow too much during exhalation...

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