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1. A 73-year-old patient with COPD, osteoarthritis, and a history of stroke is prescribed a dry powder inhaler (DPI). All of the following are potential barriers to good inhaler technique in this patient EXCEPT:

A. Insufficient inspiratory flow B. Inability to coordinate breath with device actuation C. Decreased manual dexterity D. Facial weakness E. Unsure

2. Which of the following patterns of nonadherence is MOST common among patients with asthma and COPD?

A. Reliever overuse with appropriate controller use B. Reliever underuse with controller overuse C. Reliever overuse with controller underuse D. Appropriate reliever use with controller overuse E. Unsure

3. A 44-year-old male with asthma presents to the pharmacy for inhaler device education. When asked to demonstrate the appropriate use of his pressurized metered dose inhaler (pMDI), it becomes clear that there are several errors in his inhaler technique. Which of the following errors would be the MOST critical to address, according to the results of the CRITIKAL study?

A. Inspiratory effort too fast/forceful B. Actuation of the device prior to inhalation C. Failure to seal lips tightly around the mouthpiece D. Inspiratory effort too shallow E. Unsure

4. A 79-year-old male with uncontrolled COPD presents to the pharmacy to discuss his inhaler medications. He is prescribed an albuterol dry powder inhaler (DPI) for use as needed, as well as tiotropium DPI daily and salmeterol DPI twice daily. During the conversation, he admits that he does not take all of his controller medication doses every day. He takes his tiotropium and salmeterol together in the morning, but usually forgets to take his second salmeterol dose in the evening. When asked, he is able to demonstrate correct inhaler technique for all of his devices. Which of the following barriers is most likely contributing to his nonadherence?

A. Concerns about side effects B. Lack of knowledge regarding the roles of each medication C. Physical difficulty actuating the inhaler devices D. Regimen complexity E. Unsure

5. A patient with newly-diagnosed asthma has been prescribed a fluticasone/salmeterol inhaler. Which of the following would be the MOST effective method for educating this patient on her inhaler medication?

A. Verbal instruction and physical demonstration of the inhaler device B. Videos demonstrating proper inhalation technique C. Written materials describing appropriate steps for inhaler device use D. Verbal discussion of potential side effects of the medication E. Unsure

6. Which of the following variables CANNOT be measured by digital inhaler systems?

A. Date and time of inhaler use B. Peak inhalation flow C. Number of puffs taken D. All of these can be measured by digital inhaler systems E. Unsure

7. How often should patients receive inhaler technique assessment and education?

A. Initially upon inhaler prescription, then yearly B. Initially upon inhaler prescription, then every 6 months C. Initially upon inhaler prescription, then at every patient visit D. Initially upon inhaler prescription, then upon patient request E. Unsure

8. A 57-year-old patient with mild asthma presents to the pharmacy for a refill of his albuterol inhaler. He also has a prescription for an inhaled corticosteroid; however, he states that he doesn't really use it, because it doesn't seem to do anything. How should he be counseled about his inhaler medications?

A. If your asthma symptoms are mild and infrequent, you may not need an inhaled corticosteroid; talk to your doctor about stopping this medication B. You should be using your inhaled corticosteroid inhaler instead of your albuterol inhaler whenever you have asthma symptoms C. Let's check your inhaler technique: if you are using your inhaled corticosteroid inhaler incorrectly, that may explain why you are not feeling any immediate symptom relief D. Inhaled corticosteroids help decrease the inflammation in your airways; you may not notice the effects right away, but these medications are important for controlling symptoms in the long term E. Unsure

9. A 34-year-old female with uncontrolled asthma presents to the pharmacy asking for advice on how to improve her inhaler adherence. She states that she tries to take her controller medications every day in the morning, but she often forgets because she wakes up late and has to rush to get ready for work. She really wants to start taking her controller medications more regularly, because she knows that when she doesn't, her symptoms get a lot worse. All of the following would be useful strategies to help her increase her adherence EXCEPT:

A. Encouraging her to integrate inhaler use into an established evening routine B. Engaging her in a discussion using motivational interviewing techniques C. Encouraging her to use a digital inhaler system that generates reminder notifications D. Encouraging her to keep her inhaler in a more visible location E. Unsure

10. According to a 2018 study by Merchant and colleagues, integrating data from a digital inhaler system into the clinical decision-making process for asthma patients resulted in:

A. Decreased use of short-acting beta agonists B. Increased use of controller medications C. Decreased asthma-related emergency department visits D. All of the above E. Unsure

Maintenance is scheduled for 8/7/2023 7:00 AM EST - 8:00 AM EST.

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1. A 73-year-old patient with COPD, osteoarthritis, and a history of stroke is prescribed a dry powder inhaler (DPI). All of the following are potential barriers to good inhaler technique in this patient EXCEPT:

2. Which of the following patterns of nonadherence is MOST common among patients with asthma and COPD?

5. A patient with newly-diagnosed asthma has been prescribed a fluticasone/salmeterol inhaler. Which of the following would be the MOST effective method for educating this patient on her inhaler medication?

6. Which of the following variables CANNOT be measured by digital inhaler systems?

7. How often should patients receive inhaler technique assessment and education?

10. According to a 2018 study by Merchant and colleagues, integrating data from a digital inhaler system into the clinical decision-making process for asthma patients resulted in:

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Maintenance is scheduled for 8/7/2023 7:00 AM EST - 8:00 AM EST.

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1. A 73-year-old patient with COPD, osteoarthritis, and a history of stroke is prescribed a dry powder inhaler (DPI). All of the following are potential barriers to good inhaler technique in this patient EXCEPT:

2. Which of the following patterns of nonadherence is MOST common among patients with asthma and COPD?

5. A patient with newly-diagnosed asthma has been prescribed a fluticasone/salmeterol inhaler. Which of the following would be the MOST effective method for educating this patient on her inhaler medication?

6. Which of the following variables CANNOT be measured by digital inhaler systems?

7. How often should patients receive inhaler technique assessment and education?

10. According to a 2018 study by Merchant and colleagues, integrating data from a digital inhaler system into the clinical decision-making process for asthma patients resulted in:

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