RxReady

PEBC Respiratory Practice Questions

Asthma, COPD, inhalers and cough and cold products: ten respiratory questions in the style of the PEBC MCQ.

Updated November 13, 2026. Written by RxReady to the 2026 PEBC blueprint. These are practice questions, not real or recalled exam questions.

Respiratory questions span prescription therapy and the self-care aisle. You need to know when asthma is poorly controlled, which COPD therapy fits, how inhaler devices differ, and which cough and cold products are unsafe for children or patients with hypertension.

These ten questions follow Canadian asthma and COPD guidance (CTS and GINA) and cover roflumilast, exacerbations, inhaler technique, LABA safety, referral signs and allergic rhinitis.

For self-care questions, ask first whether the patient should be referred. That is often the answer the exam is looking for.

Practice by topic

Ten respiratory questions

Question 1 · COPD

Which of the following patients with COPD is the most appropriate candidate for adding roflumilast?

  1. AFEV1 70%, emphysema, no exacerbations on a long-acting bronchodilator
  2. BFEV1 40%, chronic bronchitis, frequent exacerbations on triple therapy
  3. CFEV1 45%, underweight, with untreated depression, on triple therapy
  4. DFEV1 60%, newly diagnosed, not yet on any maintenance inhaler therapy
Show the answer

Answer: B) FEV1 40%, chronic bronchitis, frequent exacerbations on triple therapy

Roflumilast, an oral PDE4 inhibitor, is indicated as add-on therapy to reduce exacerbations in severe COPD (FEV1 below 50% predicted) associated with chronic bronchitis and a history of frequent exacerbations despite optimal inhaled therapy. Common adverse effects include diarrhea, nausea, weight loss and psychiatric effects (insomnia, anxiety, depression, suicidality), so it should be avoided in underweight patients or those with untreated depression. It is not used for mild disease or as initial therapy.

Why the other options are wrong

  • A) Mild disease (FEV1 70%) without exacerbations is not an indication for roflumilast.
  • C) Roflumilast causes weight loss and psychiatric effects, so avoid it if underweight or with untreated depression.
  • D) Roflumilast is not initial therapy; inhaled bronchodilators come first.

Key point: Roflumilast: FEV1 <50%, chronic bronchitis, frequent exacerbations despite optimal inhalers.

Question 2 · Pediatric cough and cold

TJ, a 4-year-old child, has a cough from a common cold, and her father requests a dextromethorphan syrup. Which of the following is the most appropriate recommendation?

  1. ADextromethorphan at half the adult dose
  2. BDiphenhydramine syrup at bedtime
  3. CCodeine-containing cough syrup
  4. DHoney 2.5 mL at bedtime and fluids
Show the answer

Answer: D) Honey 2.5 mL at bedtime and fluids

Health Canada advises that nonprescription cough and cold medicines not be used in children under 6 years because of lack of efficacy and risk of harm, and codeine is not indicated for children under 12. Honey (only for children older than 1 year) can modestly reduce nighttime cough, along with fluids and humidified air.

Why the other options are wrong

  • A) Health Canada advises against cough and cold products under age 6.
  • B) Diphenhydramine is not recommended for young children's coughs.
  • C) Codeine isn't indicated under age 12.

Key point: Under 6 years: no OTC cough/cold products. Honey if over 1 year.

Question 3 · Cough and cold

A 72-year-old man with benign prostatic hyperplasia asks for a product for nasal congestion from a cold. Which of the following should the pharmacist advise him to avoid?

  1. ASaline nasal spray
  2. BHoney in warm water
  3. COral pseudoephedrine
  4. DAcetaminophen
Show the answer

Answer: C) Oral pseudoephedrine

Oral decongestants increase bladder-neck smooth muscle tone and can cause urinary retention in BPH (and they raise BP). Why not the others: A: Safe and helpful for congestion, with no urinary effects. B: A safe non-drug option for cold symptoms in adults. D: Safe for aches and fever at standard doses. Key takeaway: BPH: avoid oral decongestants and first-generation antihistamines (urinary retention).

Why the other options are wrong

  • A) Saline spray is safe and helps congestion with no effect on urination.
  • B) Honey in warm water is a safe non-drug option for cold symptoms in adults.
  • D) Acetaminophen at standard doses is safe for aches and fever in BPH.

Key point: BPH: avoid oral decongestants and first-generation antihistamines (urinary retention).

Question 4 · Cough and cold

A 60-year-old man with uncontrolled hypertension (BP 162/98 mm Hg) asks for something for nasal congestion from a cold. Which of the following is the most appropriate recommendation?

  1. APhenylephrine-containing combination cold tablet
  2. BPseudoephedrine sustained-release 120 mg every 12 hours
  3. CPseudoephedrine 60 mg every 6 hours
  4. DSaline nasal spray or irrigation
Show the answer

Answer: D) Saline nasal spray or irrigation

Oral decongestants such as pseudoephedrine and phenylephrine are sympathomimetics that can raise blood pressure and should be avoided in uncontrolled hypertension. Saline spray or irrigation relieves congestion without systemic effects; a short course (up to 3 days) of a topical decongestant is an alternative with fewer systemic effects.

Why the other options are wrong

  • A) Phenylephrine is a sympathomimetic that can raise blood pressure in uncontrolled hypertension.
  • B) Pseudoephedrine (any formulation) can raise blood pressure and should be avoided here.
  • C) Pseudoephedrine can raise blood pressure and should be avoided in uncontrolled hypertension.

Key point: Uncontrolled hypertension: avoid oral decongestants; use saline (short topical decongestant if needed).

Question 5 · COPD exacerbation

RD, a 70-year-old man with COPD, has an acute exacerbation with increased dyspnea and sputum purulence. Which of the following is the most appropriate systemic corticosteroid regimen?

  1. APrednisone 50 mg daily tapered over 4 weeks
  2. BPrednisone 10 mg daily x 5 days
  3. CPrednisone 40 mg daily x 14 days
  4. DPrednisone 40 mg daily x 5 days
Show the answer

Answer: D) Prednisone 40 mg daily x 5 days

A short course of prednisone 30-50 mg daily (commonly 40 mg) for 5 days is as effective as longer courses for COPD exacerbations (REDUCE trial) and minimizes adverse effects; no taper is needed. Longer courses and tapers increase steroid exposure without added benefit, and 10 mg is subtherapeutic. An antibiotic is also indicated because of sputum purulence.

Why the other options are wrong

  • A) 50 mg tapered over 4 weeks adds steroid exposure without benefit.
  • B) 10 mg is too low for an exacerbation.
  • C) 14 days is no more effective than 5 days.

Key point: COPD exacerbation: prednisone 40 mg × 5 days, no taper.

Question 6 · Asthma

A 28-year-old woman with asthma comes to the pharmacy short of breath after taking several puffs of salbutamol. Which of the following findings indicates the need for immediate emergency care?

  1. AShe coughs at night once a week
  2. BShe uses salbutamol before exercising at the gym
  3. CShe has seasonal nasal congestion
  4. DShe is unable to speak in full sentences
Show the answer

Answer: D) She is unable to speak in full sentences

Inability to speak in full sentences, along with use of accessory muscles, drowsiness, cyanosis or no relief from a reliever, signals a severe asthma exacerbation requiring emergency care. Nocturnal cough once weekly suggests suboptimal control needing reassessment but not emergency care. Pre-exercise salbutamol and allergic rhinitis are not emergencies.

Why the other options are wrong

  • A) Night cough once a week suggests suboptimal control that needs review, but not emergency care.
  • B) Using salbutamol before exercise is appropriate prevention, not an emergency sign.
  • C) Seasonal nasal congestion is allergic rhinitis, not a sign of a severe asthma attack.

Key point: Can't speak full sentences, drowsy, cyanosis or no reliever response = asthma emergency.

Question 7 · COPD

G.D., an 80-year-old man with severe COPD, cannot generate adequate inspiratory flow for his dry powder inhaler. Which of the following is the most appropriate alternative device for his LAMA/LABA?

  1. ASoft mist inhaler (Respimat)
  2. BA different dry powder inhaler requiring a faster inhalation
  3. CpMDI used without a spacer
  4. DDry powder capsule inhaler (Breezhaler)
Show the answer

Answer: A) Soft mist inhaler (Respimat)

Soft mist inhalers produce a slow-moving aerosol that does not depend on the patient's inspiratory flow, making them suitable for patients with low inspiratory flow; tiotropium/olodaterol is available as a Respimat in Canada. Dry powder inhalers, including capsule devices, require a strong inspiratory effort. A pMDI without a spacer requires coordination that is often difficult for older adults.

Why the other options are wrong

  • B) Any dry powder inhaler needs strong inspiratory flow, and a device needing faster inhalation is even worse for him.
  • C) A pMDI without a spacer needs hand-breath coordination that is often hard for older adults.
  • D) Breezhaler is a dry powder capsule device that still needs a strong inspiratory effort.

Key point: Low inspiratory flow: use a soft mist inhaler or pMDI with spacer, not a dry powder inhaler.

Question 8 · Asthma

BT, a 34-year-old woman with asthma on fluticasone 125 mcg 2 puffs BID by MDI, uses salbutamol 4 times a week and wakes at night with cough. Which of the following is the most appropriate first step?

  1. APrescribe a 5-day course of prednisone
  2. BAssess inhaler technique and adherence
  3. CAdd montelukast 10 mg daily
  4. DIncrease fluticasone to 250 mcg 2 puffs BID
Show the answer

Answer: B) Assess inhaler technique and adherence

Her asthma is not well controlled (SABA use and night symptoms above CTS thresholds), but before stepping up therapy, poor inhaler technique, nonadherence, triggers and comorbidities must be assessed because they are the most common causes of poor control. Stepping up without this assessment exposes her to unnecessary drug and adverse effects. Prednisone is for exacerbations, and montelukast is a less effective add-on.

Why the other options are wrong

  • A) Prednisone is for exacerbations; she needs control assessed first.
  • C) Montelukast is a less effective step-up and shouldn't come before checking technique.
  • D) Increasing the ICS before checking technique may not help if she can't use the inhaler correctly.

Key point: Poor asthma control: check technique, adherence and triggers before stepping up.

Question 9 · Prescription review

KS, a 19-year-old with asthma who uses only salbutamol, presents this prescription: "Salmeterol (Serevent Diskus) 50 mcg, i inh bid, M: 1 Diskus." Which of the following is the most appropriate action?

  1. ADispense; salmeterol is appropriate maintenance therapy
  2. BDispense and advise using it as needed for symptoms
  3. CContact the prescriber; LABA without ICS is unsafe in asthma
  4. DContact the prescriber; the dosing frequency is too high
Show the answer

Answer: C) Contact the prescriber; LABA without ICS is unsafe in asthma

Long-acting beta-2 agonist monotherapy in asthma increases the risk of severe exacerbations and asthma-related death, so LABAs must always be combined with an inhaled corticosteroid (e.g., an ICS-LABA inhaler). The pharmacist should contact the prescriber to recommend an ICS-containing regimen. Salmeterol 50 mcg twice daily is the correct dose, and it is not a reliever to use as needed because of its slow onset.

Why the other options are wrong

  • A) LABA monotherapy is unsafe in asthma.
  • B) Using it as needed doesn't fix the lack of an ICS.
  • D) Twice daily is the correct frequency for salmeterol.

Key point: Never a LABA without an ICS in asthma.

Question 10 · Allergic rhinitis

A 28-year-old woman has moderate seasonal allergic rhinitis with nasal congestion, sneezing and rhinorrhea that interfere with her sleep and work. Which of the following is the most effective initial monotherapy?

  1. AIntranasal corticosteroid such as fluticasone
  2. BOral pseudoephedrine 60 mg every 4 to 6 hours
  3. CIntranasal oxymetazoline twice daily
  4. DOral diphenhydramine 25 to 50 mg at bedtime
Show the answer

Answer: A) Intranasal corticosteroid such as fluticasone

Intranasal corticosteroids are the most effective monotherapy for moderate to severe allergic rhinitis, particularly for congestion. Oral decongestants do not address sneezing or itch and have systemic adverse effects, first-generation antihistamines are sedating, and topical decongestants such as oxymetazoline should not be used longer than 3 days because of rebound congestion.

Why the other options are wrong

  • B) Pseudoephedrine does not treat sneezing or itch and has systemic adverse effects.
  • C) Oxymetazoline causes rebound congestion if used more than 3 days, so it is not suitable for a season.
  • D) Diphenhydramine is sedating and less effective than an intranasal corticosteroid.

Key point: Moderate-severe allergic rhinitis: intranasal corticosteroid is the best single drug.

Find your weakest topics

The free diagnostic grades you across all six PEBC competencies, then builds a study plan around the areas costing you the most marks. We also have 2,000+ practice questions and 98 OSCE stations where you talk to an AI patient out loud.

Take the free diagnosticTry a free OSCE station

More free study guides