NBRC AE-C Certified Asthma Educator

Which of the following best describes the underlying pathophysiology of asthma?

• APermanent fixed airflow obstruction caused by alveolar destruction
• BChronic airway inflammation with bronchial hyperresponsiveness and reversible airflow obs…
• CPleural inflammation with restrictive lung mechanics
• DPulmonary vascular hypertension with normal airway mechanics

When teaching a patient about long-term consequences of poorly controlled asthma, which structural change should the educator describe as 'airway remodeling'?

• AReversible bronchoconstriction that resolves with a SABA
• BSubepithelial fibrosis, smooth-muscle hypertrophy, and goblet-cell hyperplasia leading to…
• CPleural thickening from recurrent infections
• DAlveolar hyperinflation from chronic air trapping

A new patient asks why she gets short of breath during an asthma attack but feels fine at other times. Which simple-language explanation best matches the underlying physiology?

• AYour alveoli collapse and reopen with each breath
• BYour airway muscles tighten, the lining swells, and extra mucus forms, narrowing the brea…
• CYour blood vessels in the lungs constrict and limit oxygen delivery
• DYour diaphragm becomes paralyzed during a flare

Which statement comparing pediatric and adult asthma characteristics is MOST accurate?

• ACough-variant asthma is more common in young children than in adults
• BAtopic asthma is more common in elderly adults than in children
• CSpirometry is the preferred objective measure for children under 4 years old
• DAdult-onset asthma is almost always allergic and IgE-mediated

In NAEPP terminology, the term 'impairment' refers primarily to:

• AThe likelihood of future exacerbations or adverse medication effects
• BThe frequency and intensity of symptoms and functional limitations the patient is current…
• CThe structural changes seen on chest imaging
• DThe patient's adherence to controller therapy

A wheeze heard on auscultation during an asthma exacerbation is produced primarily by:

• APleural friction between visceral and parietal surfaces
• BAir moving turbulently through narrowed lower airways
• CFluid filling the alveolar spaces
• DAir leaking into the subcutaneous tissue

Which statement BEST distinguishes asthma 'severity' from asthma 'control'?

• ASeverity is assessed only after treatment is initiated; control is assessed at the first…
• BSeverity reflects intrinsic disease intensity (ideally before controller therapy); contro…
• CSeverity and control are interchangeable terms
• DSeverity changes daily with symptoms; control is fixed for life

A patient says she does not understand the difference between an allergen and an irritant. The BEST teaching point is:

• ABoth produce identical IgE-mediated immune responses
• BAn allergen triggers an IgE-mediated immune response in sensitized individuals; an irrita…
• CAllergens are always outdoor exposures and irritants are always indoor
• DIrritants only matter for people with allergies

Which medication class is MOST likely to provoke asthma symptoms in a sensitive adult and should be reviewed during a medication history?

• ACalcium-channel blockers
• BNon-selective beta-blockers and aspirin/NSAIDs
• CStatins
• DProton-pump inhibitors

A 32-year-old hairdresser has new wheeze and cough that improve on weekends and during a recent vacation. The MOST appropriate next step in evaluation is:

• AReassure her that asthma is not work-related
• BTake a detailed occupational exposure history and consider serial peak-flow monitoring at…
• CRecommend immediate career change before testing
• DOrder chest CT to look for pleural plaques

Which condition most commonly MIMICS asthma and should be considered when wheeze does not respond to standard therapy in a young adult?

• APulmonary arterial hypertension
• BVocal cord dysfunction (paradoxical vocal fold motion)
• CBronchiectasis
• DSarcoidosis

A patient with poorly controlled asthma has a BMI of 36, snores loudly, and has witnessed apneas. Which step BEST addresses the role of comorbidity in asthma control?

• ARefer for evaluation and treatment of obstructive sleep apnea
• BAdd a second SABA inhaler
• CStop the inhaled corticosteroid
• DOrder pulmonary CT angiography

A pregnant patient with persistent asthma is reluctant to continue her inhaled corticosteroid for fear of harming the baby. The BEST counseling point is:

• AStop all asthma medications during pregnancy
• BUncontrolled asthma poses greater risk to mother and fetus than controller medications, a…
• CSwitch to oral steroids for the entire pregnancy
• DUse a SABA only when symptoms occur and skip the controller

Which statement about second-hand smoke (SHS) and asthma is correct?

• ASHS only affects children with severe asthma
• BSHS exposure is linked to increased asthma incidence in children and worse control and mo…
• CCigar smoke is safe for people with asthma
• DSHS only matters for indoor exposure, not for residual smoke on clothing or surfaces

Which combination of indoor allergens are MOST commonly associated with persistent asthma in inner-city children?

• APollens and ragweed
• BHouse-dust mite, cockroach, mouse, and cat or dog dander
• CIndustrial isocyanates
• DStinging insect venom

Which statement BEST describes how respiratory viral infections affect asthma?

• AThey have no effect once a child is on controller therapy
• BViral upper respiratory infections, especially rhinovirus, are the most common trigger of…
• COnly influenza causes asthma exacerbations
• DAntibiotics should be prescribed routinely for any cold in a person with asthma

A patient with chronic uncontrolled GERD reports nocturnal cough and wheeze. Which strategy BEST addresses the comorbidity?

• ATreat reflux with lifestyle changes and acid suppression because untreated GERD can worse…
• BIncrease SABA frequency to four times per day
• CDiscontinue inhaled corticosteroids
• DSwitch to a leukotriene receptor antagonist alone

Which environmental control measure has the STRONGEST evidence for reducing house-dust-mite exposure in sensitized children with asthma?

• ADaily air freshener use in the bedroom
• BAllergen-impermeable mattress and pillow encasements combined with weekly hot-water washi…
• CAdding houseplants to absorb allergens
• DSwitching to wall-to-wall carpet

Which exposure is the MOST common occupational sensitizer linked to new-onset asthma in industrialized countries?

• AAsbestos fibers
• BDiisocyanates used in spray painting and polyurethane manufacture
• CRadon gas
• DCarbon dioxide

Which patient-reported feature most strongly suggests that a non-respiratory comorbidity is contributing to poor asthma control?

• AReports of nasal congestion, postnasal drip, and sneezing alongside asthma symptoms sugge…
• BUse of a written asthma action plan
• CAnnual influenza vaccination
• DDaily peak-flow monitoring

During an asthma history, which question is MOST appropriate to elicit functional impact?

• AWhat is your peak flow this morning?
• BHow many days in the past 2 weeks did asthma keep you from school, work, or activities yo…
• CWhen was your last chest x-ray?
• DWhich beta-agonist do you prefer?

Which historical feature is the STRONGEST marker of high-risk, fatal-prone asthma?

• AOne mild exacerbation in the past year
• BA prior intubation or ICU admission for asthma
• CAllergic rhinitis treated with antihistamines
• DA peak flow within the green zone today

A patient is using more than one SABA canister per month. The MOST appropriate interpretation is:

• AExcellent self-management
• BOveruse signaling poor control and increased risk of exacerbations and asthma death
• CA normal pattern for any adult with asthma
• DEvidence that the canister is defective

Which open-ended question BEST elicits the patient's perspective on barriers to controller adherence?

• AAre you taking your inhaler every day, yes or no?
• BTell me about a typical day with your inhalers - what makes it easy or hard to use them a…
• CDo you know that ICS prevent exacerbations?
• DWhy do you keep skipping your medicine?

When taking the asthma history of a 7-year-old, the educator should:

• ASpeak only to the parent and ignore the child
• BDirect developmentally appropriate questions to the child while also gathering parent-rep…
• CUse complex medical terminology to teach maturity
• DRefuse to ask about school exposures

A 60-year-old smoker reports chronic cough with morning sputum and progressive dyspnea. Which feature BEST suggests evaluating for COPD or asthma-COPD overlap rather than asthma alone?

• AEpisodic wheezing triggered by allergens since childhood
• BLong pack-year smoking history with chronic productive cough and persistent dyspnea even…
• CSymptoms triggered exclusively by exercise in cold air
• DMarked improvement with a single inhaled corticosteroid trial

Which of the following is an appropriate criterion for referral to an asthma specialist according to NAEPP?

• AAsthma well controlled on Step 2 therapy with no exacerbations in 1 year
• BDifficulty achieving control after Step 4 therapy, atypical signs/symptoms, suspected occ…
• CPatient prefers branded inhalers
• DParent requests an annual physical

On physical exam, which combination is MOST consistent with a SEVERE acute asthma exacerbation?

• ASpeaking in full sentences, RR 16, SpO2 99%
• BSpeaking in single words, accessory muscle use, RR 32, SpO2 88% on room air
• CMild end-expiratory wheeze and normal mental status
• DCough with clear chest auscultation

A patient suddenly stops wheezing during a severe exacerbation but appears more distressed and cyanotic. The educator should interpret this as:

• AImprovement, since wheeze is gone
• BA 'silent chest' indicating critical airflow limitation - call 911 immediately
• CEvidence the SABA is overdosed
• DResolution because oxygen saturation must be normal

Which physical finding is appropriately associated with its meaning?

• APulsus paradoxus > 12 mmHg in asthma typically reflects mild disease
• BUse of accessory muscles (sternocleidomastoid, scalene) in an adult correlates with signi…
• CCyanosis is an early sign of mild hypoxemia
• DClipped, two- to three-word speech indicates excellent control

Per ATS/ERS criteria, post-bronchodilator reversibility supportive of asthma in an adult is defined as:

• AAny improvement in FEV1, regardless of magnitude
• BAn increase in FEV1 of at least 12% AND at least 200 mL from baseline
• CAn increase in FVC of 50%
• DAn increase in peak flow of 5 L/min

An adult patient has FEV1/FVC of 0.65 (below the lower limit of normal) and FEV1 75% predicted before bronchodilator. After albuterol, FEV1 increases by 18% and 320 mL. The MOST appropriate interpretation is:

• ARestrictive defect with reversibility
• BObstructive defect with significant bronchodilator reversibility consistent with asthma
• CNormal spirometry
• DMixed defect with no reversibility

Per ATS guidance, a FeNO value GREATER than which threshold suggests eosinophilic airway inflammation and likely corticosteroid responsiveness in an adult?

• A5 ppb
• B25 ppb
• C50 ppb
• D200 ppb

When teaching peak expiratory flow (PEF) measurement, the patient should:

• ATake a slow, partial breath in and a long slow blow out
• BStand or sit upright, take a deep maximal inhalation, place the mouthpiece, seal the lips…
• CBlow in the mouthpiece slowly for as long as possible
• DTake three breaths through the meter without sealing the lips

A patient's personal-best peak flow is 500 L/min. Today's reading is 320 L/min. This places the patient in which zone of a written asthma action plan?

• AGreen zone (well controlled)
• BYellow zone (caution)
• CRed zone (medical alert)
• DAbove personal best

A patient describes new-onset cough and wheeze with normal spirometry between symptoms. The clinician orders a methacholine challenge to evaluate airway hyperresponsiveness. The educator explains that:

• AThe test confirms asthma when FEV1 increases by 20% after the highest dose
• BA positive test (PC20 less than 8 mg/mL off ICS) suggests airway hyperresponsiveness cons…
• CThe test is performed to assess for COPD
• DPatients should take their SABA right before the test

Which factor MOST commonly invalidates a peak-flow measurement?

• AUse after a heavy meal
• BCoughing into the mouthpiece, blocking the mouthpiece with the tongue, or failing to give…
• CStanding rather than sitting
• DUsing a peak-flow meter that has been used for less than 6 months

Which assessment provides the BEST insight into a patient's health-literacy level?

• AAsking the patient to read the medication label out loud and explain when and how they wo…
• BReviewing the patient's insurance card
• CCounting how many medications the patient takes
• DChecking the patient's age

Which assessment finding suggests an ECONOMIC barrier to asthma self-management?

• APatient reports skipping ICS doses to make the canister last longer because of cost or in…
• BPatient is allergic to cats
• CPatient prefers DPI over MDI
• DPatient lives in a single-family home

Which question BEST assesses readiness to learn?

• AHave you had asthma for a long time?
• BWhat is the most important thing about your asthma you would like to work on today?
• CHow old are you?
• DDo you have insurance?

When conducting a culturally responsive asthma assessment, which behavior is MOST appropriate?

• AAssume all members of a cultural group share identical health beliefs
• BAsk open questions about the patient's understanding of asthma, traditional remedies, fam…
• CAvoid asking about cultural beliefs to seem neutral
• DUse medical jargon to demonstrate professionalism

When the educator must teach a Spanish-speaking patient with limited English proficiency, the BEST approach is to:

• AUse the patient's school-aged child as the interpreter for medical decisions
• BUse a qualified medical interpreter (in-person, phone, or video) and provide written mate…
• CSpeak louder in English
• DSkip the teaching session and provide a pamphlet only

A patient says her grandmother brews a tea she takes daily 'for the lungs.' The MOST appropriate response is to:

• ATell her to stop using it immediately without further discussion
• BAsk the name and ingredients of the tea, document its use, and check for interactions wit…
• CEndorse the tea as harmless because it is natural
• DRefuse to provide further teaching unless she stops

Which medication is the FIRST-LINE long-term controller for persistent asthma in patients aged 12 and older?

• AShort-acting beta-agonist (SABA) alone
• BInhaled corticosteroid (ICS), often combined with formoterol per current NAEPP and GINA r…
• COral corticosteroid daily
• DTheophylline

In SMART (single maintenance and reliever therapy), the maintenance and reliever inhaler contains:

• AAlbuterol alone
• BInhaled corticosteroid plus formoterol (a long-acting beta-agonist with rapid onset)
• CInhaled corticosteroid plus salmeterol
• DTiotropium

Per the 2020 NAEPP Focused Update, the preferred Step 3 therapy for individuals aged 4 years and older is:

• ADaily medium-dose ICS plus as-needed SABA
• BDaily LOW-dose ICS-formoterol used as both daily controller and reliever (SMART)
• CDaily LABA monotherapy
• DDaily oral corticosteroid

GINA 2024 describes two treatment 'tracks.' Track 1 (preferred for most adults and adolescents) uses which reliever?

• AAs-needed SABA only
• BAs-needed low-dose ICS-formoterol
• CAs-needed ipratropium
• DAs-needed oral prednisone