Common Registration Assessment · Topic deep-dive
GPhC Asthma and COPD Questions
Respiratory was flagged in the Board of Assessors’ June 2025 feedback as a Part 2 weak area, specifically asthma management (acute, chronic, stepping up and stepping down) and COPD inhaled therapy. The 2024 BTS/NICE/SIGN joint guideline updated asthma management substantially — older revision sites still teach the previous stepwise approach.
What the GPhC actually tests on this topic
- Acute asthma management: severity assessment, oxygen, bronchodilators, oral or IV corticosteroids, escalation triggers
- Chronic asthma stepping up: when to start ICS, when to add LABA, MART (Maintenance and Reliever Therapy) regimens, when to refer
- Chronic asthma stepping down: when, how, and what to do if symptoms recur
- COPD inhaled therapy: GOLD/NICE pathway, when to add LABA, LAMA, ICS, when to discontinue
- Inhaler class identification and patient counselling — common errors and check-the-technique steps
Common pitfalls — from the Board of Assessors’ feedback
Out-of-date asthma stepwise guidance
The 2024 BTS/NICE/SIGN joint asthma guideline replaced separate BTS and NICE pathways. Older revision content describes the previous stepped pathway. The Board of Assessors expects current guidance. Check the 2024 joint guideline before drilling stepping-up questions.
MART regimen confusion
A MART regimen uses a combination ICS-formoterol inhaler for both maintenance and reliever use. It is not interchangeable with “take your blue inhaler when needed”. Exam questions test whether you can identify a MART regimen and counsel a patient correctly on its use.
Adding ICS to COPD
NICE specifies eosinophil count thresholds and exacerbation frequency for adding an ICS in COPD. The default-ICS answer is wrong if the patient does not meet the criteria. Recent NICE updates emphasise withdrawing ICS in COPD where there is no clear benefit.
Inhaler technique counselling
The Board of Assessors flagged inhaler technique as part of the broader respiratory weakness. Know the differences between pMDI, DPI, and soft-mist inhaler technique, and the common errors patients make with each.
Sample practice questions
CRA-style practice questions, not real exam questions. The Board of Assessors does not endorse third-party question banks.
A clinical pharmacist is reviewing Mr O'Brien, a 57-year-old male with co-existing AF on warfarin (target INR 2.0-3.0), frequent INR fluctuations, and CKD stage 3. Current medications include metformin 1 g BD, gliclazide 80 mg BD, ramipril 5 mg OD, and atorvastatin 40 mg ON. HbA1c 72 mmol/mol. Fasting glucose 12.4. eGFR 45. ACR 8 mg/mmol. In the context of this clinical picture, a patient diagnosed with type 2 diabetes is interested in lifestyle interventions to manage their condition. Which of the following recommendations is NOT appropriate?
- A. Engage in 150 minutes of moderate exercise weekly
- B. Follow a low-carbohydrate diet
- C. Limit alcohol intake to one drink per day
- D. Take a daily multivitamin
- E. Monitor blood glucose levels regularly
Show worked answer
Correct answer: D
Which type of dosage form is suitable for a drug with high first-pass metabolism to achieve systemic effects?
- A. Oral tablet
- B. Sublingual tablet
- C. Topical gel
- D. Rectal suppository
- E. Intramuscular injection
Show worked answer
Correct answer: B
Asthma and COPD — frequently asked
Which asthma guideline does the GPhC exam use?
The 2024 BTS/NICE/SIGN joint guideline on asthma. It replaced the separate BTS and NICE guidelines. Revision material that teaches the old separate stepwise approach is out of date.
How are COPD treatment decisions made in the CRA?
Per NICE NG115. Inhaled therapy depends on symptom severity, exacerbation frequency, blood eosinophil count, and whether asthma features are present. Triple therapy (LABA + LAMA + ICS) has specific indications and is not the default for all symptomatic patients.
What is a MART regimen?
Maintenance and Reliever Therapy. A combination ICS-formoterol inhaler is used both as regular maintenance and as a reliever for symptoms. Salbutamol is not used as a separate reliever on a MART regimen. The 2024 BTS/NICE/SIGN guideline recommends MART as first-line for many patients.
How do I revise asthma and COPD for the GPhC exam?
Read the 2024 BTS/NICE/SIGN joint asthma guideline cover to cover, then NICE NG115 for COPD. Build a flashcard set on stepping up, stepping down, and MART. Practise 30–50 respiratory questions with a mistake log. Watch one MART counselling video and one pMDI technique video — both are testable.
Practise asthma and copd questions in context
Across the full bank of GPhC exam questions — every format, with worked answers grounded in the Board of Assessors’ published feedback.