PHARMASTE · POCKET GUIDE

Asthma & COPD

Study essentials · Version 2 · Reviewed September 28, 2026

Focused adult pharmacy study guide accompanying 40 original chapter questions. This is not a complete treatment protocol. Apply the exact diagnosis, device, product label and written patient-specific plan. Pediatric treatment, biologic selection and advanced respiratory support require additional guidance. GINA recommendations and U.S. product labeling can differ.

Put it into practice

1. Confirm the diagnosis; assess symptoms and risk

Asthma: look for respiratory symptoms that vary over time plus objective evidence of variable expiratory airflow. Obtain lung-function testing before starting controller treatment when feasible. A normal result on an asymptomatic day does not by itself exclude asthma.
Assess recent asthma symptoms separately from future exacerbation risk. Ask about night waking, activity limits, reliever use, prior exacerbations and intensive-care history; review lung function, smoking, adherence and technique.
COPD: in the appropriate clinical setting, post-bronchodilator FEV1/FVC below 0.70 establishes persistent obstruction. Symptoms, exposures, exacerbations and alternative diagnoses still need assessment; one number is not the entire diagnosis.
New orthopnea, edema, rapid weight gain, chest pain or disproportionate breathlessness should prompt assessment for other causes such as heart failure, pneumonia or pulmonary embolism.

Pause & recall
Why can an adult with few weekly asthma symptoms still need a careful risk review?

Sources: GINA 2026 Global Strategy for Asthma Management and Prevention, May 2026 · GOLD 2026 Global Strategy for Prevention, Diagnosis and Management of COPD, version 1.3, 8 December 2025

2. Make the asthma maintenance and reliever plan explicit

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Make the asthma maintenance and reliever plan explicit
Checkpoint	Practical meaning
Anti-inflammatory treatment	Adult asthma treatment should contain ICS. LABA without ICS is unsafe in asthma. A brief prednisone course does not replace long-term inhaled treatment.
GINA Track 1	At Steps 1–2, selected low-dose ICS-formoterol is used as needed. At higher steps, MART adds scheduled maintenance doses of an appropriate ICS-formoterol product plus as-needed doses. Verify strength, age, maximum total inhalations and the written plan.
Guideline versus U.S. label	The consulted U.S. SYMBICORT label describes maintenance dosing and does not indicate relief of acute bronchospasm. Prescribed guideline-based MART must be explained clearly; do not substitute an arbitrary ICS-LABA inhaler.
Alternative anti-inflammatory reliever	GINA Track 2 includes ICS-SABA options. U.S. AIRSUPRA is albuterol-budesonide, labeled for as-needed use in adults at least 18 years old. One dose is 2 inhalations; maximum 6 doses/12 inhalations per 24 hours. Continue prescribed maintenance therapy.
Step-down and referral	After sustained control, consider a gradual supervised reduction to the minimum effective ICS-containing plan. Do not routinely stop ICS. If optimized high-dose therapy still fails, refer for specialist assessment rather than choosing a biologic arbitrarily.
Pregnancy	Maintain effective ICS-containing therapy with follow-up. Uncontrolled asthma and exacerbations create maternal and fetal risk; pregnancy is not a reason for automatic withdrawal.

Pause & recall
Why can two inhalers both contain an ICS yet have different roles in the action plan?

3. Separate initial COPD treatment from follow-up

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Separate initial COPD treatment from follow-up
Situation	GOLD 2026 checkpoint
Initial group A	No moderate/severe exacerbation in the prior year and a lower symptom burden: provide a bronchodilator selected for the individual. A long-acting option is preferred unless breathlessness is very occasional.
Initial group B	No moderate/severe exacerbation but greater symptoms, such as mMRC at least 2: LABA-LAMA is preferred when suitable and accessible.
Initial group E	One or more moderate or severe exacerbations in the previous year now qualifies. Prefer LABA-LAMA; consider initial triple therapy when eosinophils are at least 300 cells/µL.
Exacerbation on LABA-LAMA	Recheck technique and adherence. Consider triple therapy; ICS benefit is more likely at eosinophils at least 100 cells/µL and rises with higher counts. Counts below 100 predict little or no preventive benefit.
Dyspnea without exacerbations	Assess other causes and function. Consider rehabilitation and a suitable change of device or bronchodilator molecules. Breathlessness alone does not automatically require ICS.
Concomitant asthma	Include ICS according to asthma treatment principles. Do not apply the COPD-only ICS pathway to established coexisting asthma.
Recurrent pneumonia on ICS	Reassess benefit and harm with the prescriber. Withdrawal may be considered for significant adverse effects; eosinophils at least 300 increase the likelihood of exacerbations after withdrawal.

Pause & recall
How does treatment review differ for persistent dyspnea versus another exacerbation?

Sources: GOLD 2026 Global Strategy for Prevention, Diagnosis and Management of COPD, version 1.3, 8 December 2025

4. Recognize deterioration; treat the correct problem

Severe breathing difficulty, drowsiness, inability to speak normally or a silent chest needs emergency assessment. A reliever that fails to help or is needed more than usual signals a need for reassessment; do not simply exceed the prescribed maximum.
Adult asthma: a clinician may prescribe prednisone/prednisolone 40–50 mg orally each day for 5–7 days for an appropriate exacerbation. Tapering is generally unnecessary for less than 2 weeks of treatment; chronic steroid use or adrenal disease needs a separate plan. Continue ICS-containing therapy, review technique and arrange early follow-up.
Adult COPD: initial acute bronchodilation uses a SABA with or without a SAMA. For an appropriate significant exacerbation, GOLD recommends prednisone-equivalent 40 mg daily for 5 days. Oxygen and ventilatory support require monitored clinical assessment.
Antibiotics are not routine for an asthma exacerbation without strong evidence of infection. In COPD, increased sputum purulence with another relevant worsening symptom, certain prior positive cultures, or a need for mechanical ventilation can support antibiotics. Select the agent and duration from the clinical setting, microbiology and local resistance.
Daily oral corticosteroids are not routine stable-COPD maintenance treatment. A successful short course does not justify indefinite prednisone.

Pause & recall
Why does an asthma exacerbation without infection not automatically need an antibiotic?

Sources: GINA 2026 Global Strategy for Asthma Management and Prevention, May 2026 · GOLD 2026 Global Strategy for Prevention, Diagnosis and Management of COPD, version 1.3, 8 December 2025 · AIRSUPRA U.S. prescribing information, revised September 2025

5. Check the medicine and the device together

Ask the patient to demonstrate each device. Check loading, priming, inhalation, coordination, breath-holding and cleaning against that exact product’s instructions. pMDIs and DPIs are not taught with one universal technique.
A compatible spacer or valved holding chamber can correct pMDI coordination problems. QVAR REDIHALER is a breath-actuated example whose label prohibits a spacer or holding chamber. Verify exact-product compatibility rather than assuming.
For an ICS, use correct technique and follow mouth-rinsing instructions; spit out the rinse water. Do not stop effective anti-inflammatory treatment merely to avoid a manageable local effect.
Check remaining doses, refill access and product-specific storage. MART supply estimates must account for both scheduled and variable reliever use.
Review new medicines, including eye drops. Ophthalmic timolol is contraindicated with asthma or a history of asthma; systemic absorption can cause bronchospasm. Assess symptoms promptly and coordinate an alternative plan with the prescriber. Selected cardioselective beta-blockers for compelling cardiac indications require a separate individualized assessment.

Pause & recall
What can an observed demonstration reveal that a refill record cannot?

Sources: GINA 2026 Global Strategy for Asthma Management and Prevention, May 2026 · SYMBICORT U.S. prescribing information, DailyMed repackaged label revised March 2026 · AIRSUPRA U.S. prescribing information, revised September 2025 · QVAR REDIHALER U.S. prescribing information, revised September 2025 · Timolol maleate ophthalmic solution U.S. prescribing information, Micro Labs, updated October 3, 2024

6. Support the person between visits

Provide a plan that names each inhaler’s role, usual dose, response to worsening symptoms, maximum permitted use and urgent-care triggers. Use teach-back and schedule reassessment.
Offer behavioral support plus an appropriate cessation medicine for tobacco dependence. Previous relapse is a reason to refine support, not to stop offering help.
Encourage suitable physical activity. Pulmonary rehabilitation adds structured exercise, education and self-management support for people with COPD who need it.
Review recommended vaccinations, exposures, comorbidities and ability to obtain medicines. Use the current immunization schedule and individual indications rather than assuming every adult needs the same products now.
Asthma before exercise: a patient using prescribed ICS-formoterol reliever may use it beforehand when needed within the plan’s limits. Do not add a second LABA or recommend unlimited inhalations.

Pause & recall
What should a written action plan add beyond the prescription label?

Sources: GINA 2026 Global Strategy for Asthma Management and Prevention, May 2026 · GOLD 2026 Global Strategy for Prevention, Diagnosis and Management of COPD, version 1.3, 8 December 2025

7. Keep quantities and units separate

Swipe or scroll to read the full table.

Keep quantities and units separate
Task	Worked example
Course quantity	An order for prednisone 50 mg daily for 5 days, using 10-mg tablets: 50 ÷ 10 × 5 = 25 tablets. Calculate the supplied order; do not infer a regimen from tablet size.
Percentage of personal-best PEF	Measured 320 L/min ÷ personal best 500 L/min × 100 = 64%. Interpret with symptoms and the individual written action plan.
AIRSUPRA units	Each inhalation supplies albuterol 90 mcg/budesonide 80 mcg. Two inhalations make one dose: 180 mcg/160 mcg. The maximum is 6 such doses, not 12 two-inhalation doses.

Pause & recall
What is the difference between a dose, an inhalation and the strength per inhalation?

Abbreviations

ICS: inhaled corticosteroid
LABA: long-acting beta2 agonist
LAMA: long-acting muscarinic antagonist
SABA: short-acting beta2 agonist
SAMA: short-acting muscarinic antagonist
MART: maintenance-and-reliever therapy with an ICS-formoterol inhaler
AIR: anti-inflammatory reliever
OCS: oral corticosteroid
COPD: chronic obstructive pulmonary disease
FEV1: forced expiratory volume in 1 second
FVC: forced vital capacity
PEF: peak expiratory flow
pMDI: pressurized metered-dose inhaler
DPI: dry-powder inhaler
mMRC: modified Medical Research Council dyspnea scale
GINA: Global Initiative for Asthma
GOLD: Global Initiative for Chronic Obstructive Lung Disease

Sources & verification

Guide reviewed September 28, 2026. Source checks are dated below. These selected teaching points use the guidance and product references below. Confirm current labeling, the patient's circumstances, and local protocols before applying a regimen.

GINA 2026 Global Strategy for Asthma Management and Prevention, May 2026 — Sections 1–6, 8 and 9: diagnosis, assessment, treatment tracks, devices, self-management, pregnancy, severe asthma and exacerbations · Checked September 28, 2026 https://ginasthma.org/wp-content/uploads/2026/05/GINA-2026-Strategy-Report-WMS.pdf
GOLD 2026 Global Strategy for Prevention, Diagnosis and Management of COPD, version 1.3, 8 December 2025 — Chapters 2–5 and pharmacological therapy appendix: assessment, ABE initial grouping, follow-up treatment, exacerbations and comorbidity · Checked September 28, 2026 https://goldcopd.org/wp-content/uploads/2026/01/GOLD-REPORT-2026-v1.3-8Dec2025_WMV2.pdf
SYMBICORT U.S. prescribing information, DailyMed repackaged label revised March 2026 — Sections 1–2 and 5: U.S. maintenance indication, acute-use limitation, administration and safety · Checked September 28, 2026 https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=a645756c-c692-4bc6-a858-7e7e249561bd
AIRSUPRA U.S. prescribing information, revised September 2025 — Sections 1–3, 5.1 and Patient Information: adult as-needed indication, dose limits and continuation of prescribed maintenance treatment · Checked September 28, 2026 https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=e60aa9f9-5139-44df-b886-ebddc3c7eb13&type=display
QVAR REDIHALER U.S. prescribing information, revised September 2025 — Section 2.1: breath-actuated administration and no spacer or holding chamber · Checked September 28, 2026 https://www.dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=cada897a-264e-450d-ae00-36e7fe747080&type=display
Timolol maleate ophthalmic solution U.S. prescribing information, Micro Labs, updated October 3, 2024 — Contraindications and Warnings: asthma, systemic absorption and bronchospasm · Checked September 28, 2026 https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=6c9f3971-8c07-4d3a-915d-76438baa2a0b