Respiratory System: Asthma, COPD and Inhalers in the GPhC Assessment

Scope and time budget

Expect short, practical scenarios: an inhaler technique problem, a patient using too much reliever, a request for a cough remedy or a person with COPD who is breathless.

What is tested

• Asthma stepwise treatment. BTS, NICE and SIGN guidance and inhaler technique.
• Asthma attacks. Recognising acute severity.
• COPD. Long-term management and exacerbations.
• Inhaler devices. Device selection, spacer use and carbon footprint.
• Oxygen therapy. Targets and alert cards.
• Cough and cold. Remedies, with pseudoephedrine restrictions.
• Allergic rhinitis. Antihistamines and nasal steroids.
• Montelukast. Neuropsychiatric warnings.
• Cystic fibrosis and pulmonary fibrosis. Medicines principles.
• Smoking cessation. Pulmonary disease and stopping smoking.

UK guideline anchors

• BTS, NICE and SIGN asthma guideline. The stepwise approach, with the emphasis on an inhaled corticosteroid in the plan. Confirm the current pathway.
• NICE COPD guideline. Bronchodilator and steroid choices.
• OTC limits (to confirm). Pseudoephedrine sales are restricted, with a limit we recall as 720 mg per sale.
• MHRA. Montelukast neuropsychiatric warning.
• BNFc. Child doses and device suitability by age.

Asthma in detail

Asthma questions test whether the therapy matches the severity and whether the patient can use the device. Follow the joint BTS, NICE and SIGN guideline for the stepwise approach, and know the principle that a reliever alone is no longer the whole picture for many adults: the guidance emphasises an inhaled corticosteroid in the treatment plan. Confirm the exact current pathway in the guideline. Be ready for questions on how to use a pressurised metered-dose inhaler, why a spacer helps, how to rinse the mouth after an inhaled steroid, and what a rising reliever use means.

Asthma attacks are a medical emergency. Know the features of a severe attack, the instruction to call for help, and the role of oral steroids. In children, the BNFc governs doses, and device choice depends on age.

COPD, oxygen and devices

For COPD, know the combination of long-acting bronchodilators and the place of inhaled steroids, and the rescue pack idea for exacerbations under clinical direction. Oxygen therapy questions turn on target saturation and the danger of too much oxygen in people at risk of carbon dioxide retention, which is why oxygen alert cards exist. Inhaler device selection is also a stewardship issue: the carbon footprint of different devices is part of current guidance, but the clinical need and the patient's technique come first.

Cough, cold and allergy

Over-the-counter questions combine pharmacology with law and red flags. Pseudoephedrine is restricted: we recall a limit of 720 mg per sale, but confirm the current limit. Codeine linctus and codeine-containing analgesics carry dependence concerns. Sedating antihistamines should be used with caution in older people and in children. Persistent cough lasting more than three weeks, blood in sputum, breathlessness or weight loss are red flags. Montelukast carries a warning about neuropsychiatric reactions, which patients and parents should know.

Counselling points that earn marks

• Reliever and preventer. Explain which inhaler is for symptoms and which is taken every day even when well. Many patients stop a preventer when they feel fine.
• Technique. Shake a pressurised inhaler, breathe in slowly and steadily, hold the breath for about ten seconds, and wait before a second puff. Dry powder devices need a fast, deep breath instead.
• Spacers. Use with pressurised inhalers in children and anyone with poor coordination, and wash them as the leaflet directs.
• Steroid inhalers. Rinse the mouth after use and report a hoarse voice or oral thrush.
• Action plan. Know when to increase treatment and when to seek urgent help.

Smoking cessation

Smoking cessation links respiratory disease to public health. Know the nicotine replacement formulations, how to combine a patch with a short-acting product, the prescription options and their cautions, and the evidence that behavioural support improves quiet attempts. A person with cardiovascular disease or in pregnancy needs particular advice, so check the BNF. Expect a question about what to advise someone who has relapsed or who is worried about weight gain.

Children

Children make up around one question in five, and asthma is the commonest chronic condition among them. Questions test device choice by age, the use of spacers with masks, growth and inhaled steroids, and the recognition of a severe attack in a child. Doses come from the BNFc.

If you have only an hour

Spend 20 minutes on the asthma pathway and the exact wording of the safety messages about relievers and preventers. Spend 20 minutes describing, aloud, how to use each inhaler type. Spend 10 minutes on COPD and oxygen, and 10 minutes on the OTC restrictions and red flags. Then do fifteen questions and log every miss by cause. Respiratory content is compact, so a short, repeated pass beats one long session.

Three typical traps

1. The reliever trap. A patient using a reliever daily or increasing its use needs a review, not just another prescription.
2. The technique trap. The right drug in the wrong technique does not work. Choose the answer that fixes technique or device.
3. The oxygen trap. More oxygen is not always better. Know who is at risk of carbon dioxide retention.

How to revise it

1. Rehearse technique. Describe, step by step, how to use each common device.
2. Draw the pathway. One page for asthma, one for COPD.
3. List the OTC restrictions. Which sales are limited and why.
4. Revise children. Spacers, masks and age limits.
5. Do short sets. Fifteen questions on devices and counselling.

Continue with gastro-intestinal and the infection domain. Back to the hub.