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GPhC BNF > RESPIRATORY > Flashcards

RESPIRATORY Flashcards

1
Q

12+, child is small or prepubertal, anaphylaxis?

A

300mcg

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2
Q

A 7-year-old child has been experiencing symptoms of wheeze on most days of the week, as well as nocturnal symptoms causing
them to wake during the night. A diagnosis of asthma is made.
Which of the following is the most appropriate first-line therapy for this child?

A

paediatric low dose inhaled corticosteroid maintenance therapy in addition to short-acting beta-2 agonist reliever therapy

cos he’s wheezing, not controlled, blah blah

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3
Q

PREDNISOLONE ACUTE ASTHMA ATTACK?

A

Child 1 month–11 years
1–2 mg/kg once daily (max. per dose 40 mg) for up to 3 days, longer if necessary.

12+ +adults
40–50 mg daily for at least 5 days.

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4
Q

salbutamol+prednisolone?

A

corticosteroid, interaction, hypokalaemia!

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5
Q

salbutamol+ibuprofen?

A

no interaction, calm

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6
Q
  1. According to the BTS/SIGN Guidelines (2019), when should an inhaled corticosteroid be considered as a preventer therapy in adults?
A

E. during all stages of the asthma management plan

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7
Q

SYBMICORT TURBOTURBO TURBO HALER?

A

INHALE QUICK AND DEEP

DPI

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8
Q

theophylline side-effect?

A

diarrhoea still

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9
Q

trimbow?

A

beclomethasone
formoterol
glycopyrronium

LABA+LAMA+ICS

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10
Q

WHAT DRUG GLAUCOMA RISK?

A

T^2

tiotropium
topiramate

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11
Q

Qvar® has extra-fine particles, is more potent than traditional beclometasone dipropionate CFC-containing inhalers and is approximately twice as potent as Clenil Modulite®.

A

Kelhale alsox2 standard inhalers

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12
Q

COPD, IPRATROPIUM+TIOTROPIUM?

A

Both not needed, hold the tio temporarily (acute exacerbation, cos LAMA, long acting)

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13
Q

b-blocker monitor?

A

bp+hr

risk of hyperkalaemia

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14
Q

ace monitor?

A

k+ levels/renal function

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15
Q

ACUTE ASTHMA

MODERATE
PEAK FLOW?
CAN COMPLETE..?
spO2?

RESPIRATORY RATE
Children 5+?
Children 1-5?

A

MODERATE
PEAK FLOW? >/= 50%
CAN COMPLETE..? full sentences
spO2? >/= 92%

RESPIRATORY RATE
Children 5+? = 30/min
Children 1-5? = 40/min

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16
Q

ACUTE ASTHMA

SEVERE
PEAK FLOW?
UNABLE TO..?

RESPIRATORY RATE
ADULT?
CHILDREN 5+?
CHILDREN 1-5?

A

SEVERE
PEAK FLOW? 33-50%
UNABLE TO..? Complete full sentences

RESPIRATORY RATE
ADULT? >/= 25
CHILDREN 5+? >30
CHILDREN 1-5? >40

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17
Q

ACUTE ASTHMA

LIFE-THREATENING
PEAK FLOW?
spO2?

SYMPTOMS? CASHE

A

LIFE-THREATENING
PEAK FLOW? <33%
spO2? <92%

SYMPTOMS? CASHE
CYANOSIS
ALTERED CONSCIOUSNESS
SILENT CHEST
HYPOTENSION
EXHAUSTION
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18
Q

ACUTE ASTHMA- ADULTS

MODERATE TREATMENT?

A

High-dose SABA (salbutamol)- pmi+spacer

Up to 10 puffs

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19
Q

ACUTE ASTHMA- ADULTS

SEVERE/LIFE-THREATENING TREATMENT?

A

High-dose SABA (salbutamol) via oxygen-driven nebuliser AND/OR nebulised ipratropium

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20
Q

ACUTE ASTHMA- ADULTS

NEAR-FATAL TREATMENT (poor response to initial therapy)?

A

IV aminophylline

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21
Q

ACUTE ASTHMA- ADULTS

ALL PATIENTS?
Contraindicated?

A 
ALL PATIENTS?
Oral prednisolone
   Contraindicated?
   IV hydrocortisone
   OR
   IV methylprednisolone
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22
Q

ACUTE ASTHMA- ADULTS

What do you give to hypoxaemic patients?

A

Supplementary oxygen (to maintain spO2 between 94-98%)

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23
Q

ACUTE ASTHMA- CHILDREN

>2 YEARS OLD TREATMENT
Life-threatening? 
1st LINE?
   Mild-moderate route?
   Severe route?
A

> 2 YEARS OLD TREATMENT
Life-threatening? Supplementary O2 to achieve >94%
1st LINE? SABA (salbutamol)
Mild-moderate? via PMI+spacer ( 10 puffs L? 999)
Severe? via oxygen-driven nebuliser

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24
Q

ACUTE ASTHMA- CHILDREN

> 2 YEARS
Poor response to 1st line?
2nd poor response?
In all cases, give..?

A

> 2 YEARS
Poor response to 1st line? nebulised SABA+ipratropium
2nd poor response? add in IV magnesium sulfate
In all cases, give..? 3 days oral prednisolone

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25
Q

ACUTE ASTHMA- CHILDREN

<2 YEARS TREATMENT
1st LINE?
POOR RESPONSE TO 1ST LINE?

A

<2 YEARS TREATMENT
1st LINE?
Immediate oxygen+trial a SABA

POOR RESPONSE TO 1ST LINE?
Combined nebulised ipratropium bromide

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26
Q

CHRONIC ASTHMA- LFESTYLE CHANGES?

A

WEIGHT LOSS if overweight
SMOKING CESSATION
BREATHING EXERCISE PROGRAMMES

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27
Q

ASTHMA TREATMENT- ADULTS

STEP 1?

STEP 2?

STEP 3?

STEP 4?

STEP 5?

A

STEP 1? SABA

STEP 2? SABA+ low dose ICS (100mcg/ beclomethasone)
Start ICS if asthma is uncontrolled with just SABA:
>/=3x a week SABA use
>/3x a week symptoms
>/= 1x night-time wakey wakey
>/= x1 inhaler use/month

STEP 3? SABA+ICS+
LTRA- montelukast (NICE)
OR
LABA- salmeterol/formoterol (BTS/SIGN) fixed dose
MART (maintenance & reliever therapy) e.g.
Fostair- beclometasone w/ formoterol
Symbicort/DuoResp Spiromax- budesonide w/formoterol turbohaler/dry powder inhaler

STEP 4? +LABA if not already added
Can be given with/without LTRA
Can convert fixed dose LABA+moderate strength ICS into MART

STEP 5? Increase strength to high strength ICS/initiate specialist:
Theophylline
Tiotropium
Oral Corticosteroids
Monoclonal Antibodies
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28
Q

ASTHMA TREATMENT- CHILDREN>5
Same as adults but a few differences…

Step 2- Very low strength ICS?

Step 3- Add

Step 4- Replace?
LABA age?

Step 5- same again. increase ICS strength/specialist..
Tiotropium age?

LEARN SIMILARITIES
THEN
POINT OUT DIFFERENCES

A

Step 2- Very low strength ICS? Clenil 50

Step 3- LTRA

Step 4- Replace? LTRA w/ LABA if not already on LABA
MART is a shout
LABA 12+
Can’t give LABA+LTRA together in children

Step 5- same again. increase ICS strength/specialist..
Tiotropium age? 12+

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29
Q

ASTHMA TREATMENT- CHILDREN<5
Same again but subtle differences…

STEP 1?

STEP 2?

STEP 3?

A

STEP 1? Intermitent SABA, PRN?, >1 SABA device/month? Urgent referral!

STEP 2? SABA+low-dose ICS
Started if SABA poor control (>/=x3 symptoms/week, >/=x1 night-time awakening/week)
Use paediatric low dose ICS 8-week trial
ICS intolerated? Use LTRA instead

STEP 3? SABA+ICS+LTRA
Still poor? Shout a specialist!

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30
Q

WHEN DO YOU DROP DOWN?

A

When asthma has been controlled for at least 3 months
Regularly review when decreasing treatment
Maintain patients at lowest possible dose of ICS (reduce /3months, 25-50% every time)

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31
Q

COMPLETE CONTROL OF ASTHMA? NO…

A 
NO DAYTIME SYMPTOMS
NO NIGHT-TIME AWAKENING
NO ASTHMA ATTACKS
NO NEED FOR RESCUE MEDS
NO LIMITATIONS ON EXERCISE
NORMAL LUNG FUNCTION (FEV1/PEF >80% predicted/best)
MINIMAL SIDE-EFFECTS FROM TREATMENT
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32
Q

FEATURES OF COPD? LIPP

A

LIMITED AIRFLOW (bronchiolitis+emphysema)
IRREVERSIBLE
PROGRESSIVE
PERSISTENT RESPIRATORY SYMPTOMS

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33
Q

SYMPTOMS OF COPD?

RISK FACTORS?

A 
SYMPTOMS OF COPD?
(LABOURED) BREATHING
WHEEZE
CHRONIC COUGH
REGULAR SPUTUM PRODUCTION (carbocisteine key)
RISK FACTORS?
SMOKING
POLLUTION
OCCUPATIONAL EXPOSURES
GENETIC FACTORS
MAD
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34
Q

COPD TREATMENT
Continue SABA throughout all stages
Never USE SAMA+LAMA together

STEP 1?

STEP 2- NON-ASTHMATIC vs ASTHMATIC?

STEP 3- if severe exacerbation/2+ moderate ones in a year?

STEP 4- non-asthmatic still an L?

A

SABA THROGH ALL STAGES MATE

STEP 1? SABA/SAMA

STEP 2- NON-ASTHMATIC vs ASTHMATIC?
Non-asthmatic- LABA+LAMA (stop SAMA)
Asthmatic- LABA+ICS

STEP 3- if severe exacerbation/2+ moderate ones in a year?
LAMA+LABA+ICS (stop SAMA)

STEP 4- non-asthmatic still an L after 3 months?
Go back to LAMA+LABA

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35
Q

COPD PROPHYLACTIC ANTIBIOTIC?

A

AZITHROMYCIN-> x3 a week, 250mg?

OTC is only available for chalmydia

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36
Q

SABA?

A

Salbutamol

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37
Q

SAMA?

A

Ipratropium

38
Q

LABA?

A

Salmeterol

Formoterol

39
Q

LAMA?

A

Tiotropium

40
Q

ICS?

A

Beclomethasone

41
Q

LTRA?

A

Montelukast

42
Q

COPD EXACERBATIONS

Exacerbation in last year? Patients need…

A

Exacerbation in last year? Patients need…
A RESCUE PACK! (Oral corticosteroid+antibiotic)
amoxicillin
doxycycline
clarithromycin- AVOID if taking prophylactic azithromycin (both macrolides)

43
Q

COPD NON-DRUG TREATMENT?

A

POSITIVE EXPIRATORY PRESSURE- help sputum clearance

44
Q

SAMA n LAMA can’t be given same time
BUT
SABA n LABA can be given at same time

A
45
Q

COPD EXACERBATIONS- DRUG TREATMENT
WAG1 BRO
SABA/LAMA( withhold…)?

HOSPITALISED?

COMMUNITY?

WHEN DO YOU ADD AMINOPHYLLINE?

OXYGEN?

A

SABA/LAMA( withhold…) LAMA treatment if SAMA is given

HOSPITALISED? short-course prednisolone

COMMUNITY? short-course prednisolone if significant breathlessness

WHEN DO YOU ADD AMINOPHYLLINE? Inadequate response to nebulized bronchodilation

OXYGEN? If needed to ensure oxygen saturation of arterial blood levels

46
Q

INHALATION THERAPIES

SABA?
LABA?

DOSE?

A

SABA? Salbutamol/Terbutaline (4hrs action)
LABA? Salmeterol/Formoterol/Vilanterol (12hrs action)

DOSE? 1-2 puffs up to QDS (8 puffs max. daily)

47
Q

SABA/LABA CAUTIONED IN/RISKS?

A

DIABETICS (DKA risk esp. after IV)
Risk of arrythmias
Risk of QT pronlongation- hypokalaemia

48
Q

SABA/LABA SIDE-EFFECTS?

A

TREMOR
PALPITATIONS
HEADACHES
SEIZURES
ANXIETY
MUSCLE CRAMPS”!!!!!!!!!!!!!!!!!!!!!!!!!!!111
HYPOKALAEMIA (so watch out for digoxin toxicity!)

49
Q

WHAT OTHER DRUGS CAUSE QT INTERVAL PROLONGATION?

What is this again? Lol- extended interval between heart contracting and relaxing.

A

CORTICOSTEROIDS
DIURETICS
THEOPHYLLINE
SABA/LABA…

50
Q

SAMA?
LAMA?

SIDE-EFFECTS?

INTERACTIONS?

A

SAMA? Ipratropium
LAMA? Tiotropium/Aclidinium/Glycopyrronium

SIDE-EFFECTS? antimuscarinic complications
Constipation
Dry mouth
halos/blurred vision? :(

INTERACTIONS? Other antimuscarinic drugs
Hyoscine
Anti-depressants
Solifenacin

51
Q

INHALED CORTCOSTEROIDS

EXAMPLES?
DOSE?
MUST BE PRESCRIBED?
STEROID CARDS?
MONITORING IN CHILDREN?
A

EXAMPLES? Beclometasone/Budesonide/Ciclesonide/Fluticasone/Mometasone

DOSE? All BD EXCEPT Ciclesonide (OD)

MUST BE PRESCRIBED? By BRAND

STEROID CARDS? Carry steroid card if receiving long-term treatment w/ high-dose of inhaled corticosteroids

MONITORING IN CHILDREN? Height+weight in prolonged treatment monitored annually. Slow growth- paediatrician referral

52
Q

INHALED CORTICOSTEROIDS- SIDE-EFFECTS?

A

TASTE/VOICE ALTERATION
SORE MOUTH
PARADOXICAL BRONCHOSPASM

53
Q

INHALED CORTICOSTEROID- PARADOXICAL BRONCHOSPASM TREATMENT

MILD?
CHANGE?

A

MILD? Prevented by inhalation of SABA before ICS use

CHANGE? Aerosol-> DPI

54
Q

LTRA

EXAMPLES?
MHRA WARNING?
CSS?
INTERACTIONS?

A

EXAMPLES? Montelukast

MHRA WARNING? Risk of neuropyschotic reaction (speech//behavioural changes?)

CSS? Churg-Strauss Syndrome, keep an eye out for..
Eosinophilia
Vasculitic rash
Worsening pulmonary symptoms
Cardiac complications
Peripheral neuropathy

INTERACTIONS? LTRA is a CYP450 enzyme substrate so…
CYP inducers will reduce LTRA conc.
CYP inhibitors will increase LTRA conc.

55
Q

THEOPHYLLINE- HIGH-RISK DRUG!!! :O

THERAPEUTIC RANGE? Phyll ;)

WHEN DO YOU CHECK PLASMA LEVELS?

PRESCRIBE+MAINTAIN SAME?

A

THEOPHYLLINE? PHYLL ;)

THERAPEUTIC RANGE? 10-20mg/L (same as PHenytoin)

WHEN DO YOU CHECK PLASMA LEVELS?
4-6hrs after dose
5 days after starting treatment
At least 3 days after a dose adjustment

PRESCRIBE+MAINTAIN SAME? Brand (due to different bioavailability)

56
Q

THEOPHYLLINE- SIDE-EFFECTS?

A 
VOMITING
TREMOR 
PALPITATIONS
ARHYTHMIAS
DIARRHOEA
57
Q

THEOPHYLLINE- INTERACTIONS?

A

SMOKING- cessation will INCREASE theophylline conc, dose adjustment needed
FEVERS- reduces clearance of theophylline
CYP ENZYMES- inducers (reduce conc) & inhibitors (increase conc.)
HYPOKALAEMIA- corticosteroids/SABA/LABA/diuretics

58
Q

CROUP- TREATMENT

MILD?

MODERATE-SEVERE?

A

MILD? Single dexamethasone dose oral

MODERATE-SEVERE? Hospital..
Single dose of dexamethasone/prednisolone oral whilst waiting
Can’t take oral? IM dexamethasone/nebulised budesonide
Steroids an L? Nebulised adrenaline/epinephrine

59
Q

ANTIHISTAMINES, allergies

Different forms used?

A

Oral
Topical
Nasal
Eye drops

60
Q

ANTIHISTAMINES

1st generation? (more sedating) APC^2

2nd generation? (less sedating) CAt-DF

A

1st generation? (more sedating)
alimemazine/promethazine/chlorphenamine/cyclizine
(alimemazine+promethazine MORE sedating than chlorphenamine+cyclizine)

2nd generation? (less sedating)
acrivastine/cetirizine/loradatine/desloratadine/fexofenadine
(fexofenadine 120mg now OTC)

61
Q

ANTIHISTAMINES- TREATMENTS

N&V?
MIGRAINE?
INSOMNIA (occasional)?

A

N&V? Cinnarizine/Cyclizine/Promethazine

MIGRAINE? Buclizine

INSOMNIA (occasional)? prom/cyc/chlor

62
Q

ALLERGEN IMMUNOTHERAPY

What is it?

What about vaccines containing bee/wasp venom?

A

What is it?
Uses allergen vaccines containing house dust mite/animal dander/pollen extract to reduce symptoms of asthma and allergic rhinoconjunctivitis

What about vaccines containing bee/wasp venom?
Reduces risk of severe anaphylaxis

63
Q

OMALIZUMAB

WHAT IS IT?
USED AS ADDITIONAL THERAPY IN INDIVIDUALS W/?
SIDE-EFFECTS?

A

WHAT IS IT? A monoclonal antibody that binds to IgE

USED AS ADDITIONAL THERAPY IN INDIVIDUALS W/? Proven IgE-mediated sensitivity to inhaled allergens, when severe persistent allergic asthma can’t be controlled adequately with ICS+LABA

SIDE-EFFECTS? Churg-Strauss syndrome+hypersensitivity?

64
Q

ANAPYHYLAXIS- very important!

What is it?

A

Severe, life-threatening hypersensitivity reaction- airway/circ problems, caused by allergen (food/drugs/venom/latex)

65
Q

SOMEONE HAS HAD AN ANPAHYLACTIC REACTION.. WHAT DO YOU DO?!

A

1) Use auto-injector immediately (IM adrenaline/epinephrine)
2) Immediately call 999+state anaphylaxis- CPR if need be
3) Lie down+raise patient’s legs- blood flow
4) Remove the trigger
5) Repeat after 5min interval if no improvement :(
HOSPITAL…
6) High flow oxygen asap
7) IV fluids- hypotension/shock
8) Patient stabilized? Give non-sedating oral antihistamine, e.g. cetirizine
9) Oral L? Give IV/IM chlorphenamine

Persistent respiratory problems? Consider inhaled SABA w/without ipratropium

66
Q

ANAPHYLAXIS- DOSES /5minutes?

CHILD
UP TO 6 MONTHS?
6MONTHS-5 YEARS?
6-11 YEARS?
>12 YEARS?

MHRA SAFETY?

A 
CHILD
UP TO 6 MONTHS? 100-150mcg
6MONTHS-5 YEARS? 150mcg
6-11 YEARS? 300mcg
>12 YEARS? 500mcg

MHRA SAFETY? 2 autoinjectors should be prescribed+carried at all times!

67
Q

CYSTIC FIBROSIS

What is it?

A

Genetic disorder of lungs/pancreas/liver/intestine/rpr organs
Viscous sputum/chest infections/malabsorption

68
Q

CYSTIC FIBROSIS- AIM OF TREATMENT?

A

Prevent lung infection+maintain lung function

69
Q

CYSTIC FIBROSIS- DIFFERENT TREATMENTS

MUCOLYTIC?

LONG-TERM ANTIBACTERIAL?

NUTRITION/EXOCRINE PANCREATIC INSUFFICIENCY?

MONITOR FOR..?

A

MUCOLYTIC? Dornase alfa (aids clearance of mucus/sputum from lungs)

LONG-TERM ANTIBACTERIAL? Suppresses chronic Staph. Aureus, give oral anti-staph

NUTRITION/EXOCRINE PANCREATIC INSUFFICIENCY? Pancreatin (replaces pancreatic enzymes)

MONITOR FOR..? Liver disease/diabetes/bone density

70
Q 
Start ICS if asthma is uncontrolled with just SABA when?
1)
2)
3)
4)
A

1) >/=3x a week SABA use
2) >/3x a week symptoms
3) >/= 1x night-time wakey wakey
4) >/= x1 inhaler use/month

71
Q

Fostair?

A

beclometasone w/ formoterol

72
Q

Symbicort/DuoResp Spiromax?

A

budesonide w/formoterol

turbohaler/DPI

73
Q

INHALER DEVICES, METHOD

A
74
Q

PAEDIATRIC ASTHMA, LABA+LTRA? (NICE)

A

Not given together, LTRA+ replaced with LABA

Adults it’s calm

75
Q

adult asthma sab+ics+laba?

A

with/without LTRA, at discretion i guess

76
Q 
EASI BREATHE
BREATH-ACTUATED
pMDI
pMDI w/spacer
respimat
technique?
A

SLOW & STEADY, 4-5 SECONDS

77
Q

DPI

technique?

A

QUICK & DEEP, 2-3 seconds

78
Q

pMDI w/ spacer weird alternative?

A

breathe in and out through your mouth, slowly and steadily

79
Q

WHEN DO YOU BREATHE IN AND PRESS THE INHALER AT THE SAME TIME?

A

pMDI!

80
Q 
DOSE COUNTER?
BAI?
DPI?
pMDI?
pMDI w/ spacer?
A

BAI? sometimes
DPI? YES
pMDI? sometimes
pMDI w/ spacer? sometimes

81
Q

BAI CLEANING?

A

clean plastic case, never put metal canister in water

82
Q

DPI CLEANING?

A

WIPE MOUTHPIECE WITH DRY CLOTH ONLY, NEVER USE WATER TO CLEAN DPI

83
Q

pMDI CLEANING?

A

NEVER PUT IN WATER

84
Q

HOW DO YOU CLEAN SPACER?

A

USE WARM WATER, MILD DETERGENT, RINSE AND AIR DRY, DO NOT USE A CLOTH/TOWEL

CLEAN ONCE A MONTH

REPLACE EVERY 6-12 MONTHS

85
Q

spiriva drug?

A

tiotropium

86
Q

serevent accuaherl drug?

A

salmeterol

87
Q

atrovent pmdi drug?

A

ipratropium

88
Q

schedule 3 safe cus

A

temazepam

buprenorphine

89
Q
A
90
Q
  1. Inhaled combination therapy for chronic pulmonary obstructive disease refers to combinations of long-acting muscarinic antagonists (LAMA), long-acting beta2 agonists (LABA), and inhaled corticosteroids (ICS). Trelegy Ellipta is a single LABA/LAMA/ICS combination inhaler.
    Which patient below is suitable for treatment with a Trelegy Ellipta inhaler?

A. A patient requiring initial empirical treatment to relieve breathlessness and exercise limitation.

B. A patient currently using a LABA/ICS treatment who has been increasingly breathless recently due to worsening heart failure.

C. A patient currently using a LABA/LAMA treatment who has had one severe COPD exacerbation requiring hospitalisation within the last year.

D. A patient currently taking LABA/ICS treatment who has had one moderate COPD exacerbation within the last year.

E. A patient previously taking LABA/LAMA treatment whose symptoms have not improved after a 3 month trial of Trelegy Ellipta treatment.

A

Answer: C (A patient currently using a LABA/LAMA treatment who has had one severe COPD exacerbation requiring hospitalisation within the last year.)
• Patients taking LABA+ICS or LABA+LAMA who have a severe exacerbation (requiring hospitalisation) should be offered LAMA+LABA+ICS according to the NICE guideline [NGllS) on COPD.
• A - Use short-acting bronchodilators, as necessary, as the initial empirical treatment to relieve breathlessness and exercise limitation.
• B - Before starting LAMA+LABA+ICS, conduct a clinical review to ensure that the person’s day-to-day symptoms that are adversely impacting their quality of life are caused by COPD and not by another physical or mental health condition.
• D - Consider triple therapy for patients who have 2 moderate exacerbations within a year.
• E - If symptoms have not improved after a three month trial, stop LAMA+LABA+ICS and switch back to LAMA+LABA

91
Q

COPD

when do you step up to triple?

A 
1 severe
2 moderate
exacerbations
or
or QoL is peak
92
Q
  1. You receive a prescription for a spacer for a 14-year-old boy with a chest infection. He has been prescribed a salbutamol inhaler to help with wheezing.

Which of the following statements regarding the use of spacers is INCORRECT?

A. A spacer device increases the velocity of the aerosol and subsequent impaction on the oropharynx, reducing local adverse effects and reducing the amount of systemic absorption.
B. A spacer device reduces the need for coordination between actuation of a pressurised MDI and inhalation.

C. After washing a spacer device, it should be allowed to dry in air without rubbing dry with a cloth.

D. Spacer devices are particularly useful for infants, children with poor inhalation technique, or for nocturnal asthma.
E. Spacer devices should be replaced every 6-12 months.

A

A (A spacer reduces the velocity. All other statements are correct.)

GPhC BNF (48 decks)

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