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INSTRUCTIONS Asthma-COPD overlap: The NP's role in diagnosis and management



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This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.0 contact hours. Lippincott Professional Development is also an approved provider of continuing nursing education by the District of Columbia, Georgia, and Florida, CE Broker #50-1223. Your certificate is valid in all states.


Payment: The registration fee for this test is $21.95


Asthma-COPD overlap: The NP's role in diagnosis and management


Learning Outcomes: Seventy-five percent of participants will be able to demonstrate diagnosis and management for the overlap of asthma and COPD by achieving a posttest score of 70% or greater.


Learning Objectives: After reading the article and completing the posttest, the participant will be able to:


1. Describe diagnostic criteria and medical complications associated with ACO.


2. Select and interpret evidence-based and experimental diagnostic testing for patients presenting with symptoms of ACO.


3. Describe pharmacologic and non-pharmacologic strategies for managing ACO.





1. Which of the following is included in the GOLD definition of COPD?


a. several different phenotypes and a scope of underlying mechanisms


b. wheezing, shortness of breath, and chest tightness and cough that may vary


c. airway and/or alveolar abnormalities associated with exposure to noxious particlesCase-Based Assessment: Placing yourself in the role of the NP, use the scenario below to apply knowledge and skills learned in the attached article.Questions #2 - #10 are based on the following Case Scenario:Mr. W is a 50-year-old man who presents with persistent expiratory flow limitation. Upon taking a history, he explains that he was a premature baby with lung issues. He has always had severe allergic asthma and other "respiratory issues" throughout his life. He has allergic rhinitis. He is a non-smoker. He sent his electronic medical records to your office and you review his previous pulmonary function tests (FEV1 bronchodilator response of 220 mL and 12% from baseline) and bloodwork results (peripheral blood eosinophil count = 337 cells/mcL). Mr. W states that in addition to his childhood diagnosis of asthma, his last primary care provider suggested that he also has COPD.


2. Which clinical findings of Mr. W are included as major or minor criteria for ACO diagnosis?


a. asthma history, peripheral blood eosinophilia, and persistent airflow limitation


b. male gender, age, and FEV1 bronchodilator response result


c. history of prematurity, inspiratory wheezing on exam, and allergic rhinitis


3. Mr. W reports that his parents were heavy smokers in the home throughout his childhood. The impact of indoor/outdoor air pollution on his health


a. likely fulfills the major criteria for ACO of smoking history or significant air pollution exposure.


b. would not have an influence on his current symptoms.


c. is significant only if he had also smoked when he was younger.


4. A promising biomarker that is more elevated in ACO than in asthma or COPD alone is


a. periostin levels.


b. urinary L-histidine.


c. fractional exhaled nitrous oxide.


5. You suspect Mr. W may have ACO. If this diagnosis was confirmed and research testing was done on Mr. W evaluating the role of inflammatory markers in ACO, his serum levels of interleukin (IL)-8 and IL-17 would be expected to be


a. negatively correlated with his FEV1/FVC.


b. higher when compared to patients who do not have ACO.


c. significantly lower when compared to patients who do not have ACO.


6. Mr. W asks that you manage the drug regimen necessary for his respiratory conditions. Given your suspicion of a diagnosis of ACO, after taking his history and completing a clinical assessment, what is the next step in managing his treatment?


a. provide a long-term pulmonary rehabilitation program for Mr. W


b. initiate immediate immunotherapy administration for Mr. W


c. perform spirometry testing prior to starting any medications to prevent any skewed results


7. Mr. W undergoes spirometry testing and his FEV1 is <80%. These results are indicative of


a. normal flow of air in a resting subject.


b. increased exacerbation and mortality risk.


c. resolution and recovery from chronic pulmonary disorders.


8. Mr. W is diagnosed with ACO. Initial pharmacotherapy management for this diagnosis includes


a. low- or medium-dose ICS and LABA and/or LAMA.


b. SABA and maintenance dose of high-dose ICS.


c. high-dose ICS.


9. Nonpharmacologic treatment recommendations for Mr. W include


a. avoiding administration of any type of COVID-19 vaccines.


b. administration of vaccines including Tdap, PPSV23, and yearly influenza.


c. counseling on passive activity and avoiding exercise to reduce likelihood of sudden death.


10. You explain to Mr. W that there have been clinical trials looking at other medications that can help improve quality of life for patients with ACO. Which investigational medication did not show any improvement in exacerbations?


a. omalizumab


b. benralizumab


c. metformin