Wilkes University
3 MAXE · 335 GSN
W
Passan School of Nursing
EST. 1933
UNITY AMIDST DIVERSITY
NSG 533 Exam 3
R E S P I RATO RY, C A R D I OVA S CU L A R , L I P I D & A N T I COAG U L AT I O N P H A R M ACO LO G Y
INSTITUTION Wilkes University COURSE CODE NSG 533
PROGRAM Advanced Pharmacology — Graduate Nursing EXAM Exam 3 — Respiratory, CV, Anticoagulation
EXAM TITLE NSG 533 Exam 3 TOTAL QUESTIONS 65 Questions
COURSE TITLE Advanced Pharmacology FORMAT Multiple Choice — Select the Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Asthma (ICS, LABAs, LAMAs, biologics), COPD GOLD guidelines, hypertension treatment algorithm, statins, lipid-lowering agents, anticoagulation
(warfarin, heparin, NOACs), and antiplatelet therapy are all testable content.
▸ Correct answers and clinical rationales appear below each question.
▸ All content reflects NSG 533 Advanced Pharmacology course objectives.
SECTION I — RESPIRATORY, CARDIOVASCULAR & ANTICOAGULATION PHARMACOLOGY Questions 1 – 65
1. What are the symptoms of uncontrolled asthma?
A. Only nighttime symptoms
B. At least three of: daytime asthma >2x/week, nighttime awakening, reliever therapy >2x/week, and activity intolerance
C. Only activity limitation
D. Any single asthma symptom regardless of frequency
CORRECT ANSWER B — At least three: daytime symptoms >2x/week, nighttime awakening, reliever >2x/week, activity limitation
RATIONALE Uncontrolled asthma is defined by the presence of at least THREE of the following: (1) daytime asthma symptoms more than
twice a week; (2) nighttime awakening due to asthma; (3) reliever (rescue) therapy needed more than twice a week; (4) activity
limitation due to asthma. These criteria guide treatment escalation according to the stepwise approach. For symptoms
<2x/month: as-needed low-dose ICS-formoterol or as-needed low-dose ICS with SABA. For symptoms >2x/month: daily low-
dose ICS and as-needed SABA. For symptoms most days: daily low-dose ICS-formoterol and as-needed SABA or daily medium-
dose ICS. For severe daily symptoms: daily medium-dose ICS-formoterol with reliever or daily high-dose ICS with reliever.
,2. What is the treatment for asthma symptoms occurring less than twice a month?
A. Daily high-dose ICS with LABA
B. As-needed low-dose ICS-formoterol OR as-needed low-dose ICS with SABA
C. Daily oral corticosteroids
D. No treatment is needed
CORRECT ANSWER B — As-needed low-dose ICS-formoterol or as-needed low-dose ICS with SABA
RATIONALE For the mildest asthma (symptoms <2x/month), current guidelines recommend AS-NEEDED therapy: either low-dose ICS-
formoterol (budesonide-formoterol/Symbicort) as both maintenance and reliever, OR low-dose ICS used concomitantly with as-
needed SABA. This represents a shift from older guidelines that recommended SABA-only for mild intermittent asthma — ICS is
now recommended even for mild asthma because it addresses the underlying airway inflammation, not just
bronchoconstriction. The NSG 533 emphasizes the GINA (Global Initiative for Asthma) stepwise approach: treatment intensity
increases with symptom frequency and severity.
3. Which beta-blockers are contraindicated in asthma?
A. Metoprolol and atenolol
B. Nadolol, propranolol, timolol, and sotalol — these are non-selective beta-blockers that can cause bronchoconstriction
C. All beta-blockers are safe in asthma
D. Only labetalol
CORRECT ANSWER B — Nadolol, propranolol, timolol, sotalol (non-selective beta-blockers); cause bronchoconstriction
RATIONALE Non-selective beta-blockers (nadolol, propranolol, timolol, sotalol) block BOTH beta-1 (cardiac) and beta-2 (bronchial)
receptors — beta-2 blockade causes BRONCHOCONSTRICTION and can precipitate severe asthma exacerbations. These agents
are CONTRAINDICATED in patients with asthma or bronchospastic conditions. Cardioselective beta-1 blockers (metoprolol,
atenolol, bisoprolol — Choice A) have relative selectivity for cardiac beta-1 receptors and may be used with CAUTION in asthma
if absolutely necessary, though they still carry some risk at higher doses. The NSG 533 emphasizes that beta-blocker selection in
patients with respiratory disease requires careful consideration of cardioselectivity.
4. What is the hypertension treatment algorithm (Steps 1–4)?
A. Start with two agents for all patients
B. Step 1: ACEi/ARB/CCB/thiazide; Step 2: ACEi/ARB + CCB/thiazide; Step 3: ACEi/ARB + CCB + thiazide; Step 4: ACEi/ARB + CCB + thiazide +
spironolactone
C. Step 1: beta-blocker; Step 2: beta-blocker + diuretic; Step 3: triple therapy
D. Only lifestyle modifications for all stages
CORRECT ANSWER B — Step 1: ACEi/ARB/CCB/thiazide; Step 2: ACEi/ARB + CCB/thiazide; Step 3: ACEi/ARB + CCB + thiazide; Step 4: add
spironolactone
RATIONALE The current hypertension treatment algorithm follows four steps: Step 1 — monotherapy with ACE inhibitor, ARB, calcium
channel blocker (CCB), or thiazide diuretic. Step 2 — two-drug combination: ACEi or ARB + CCB or thiazide diuretic. Step 3 —
three-drug combination: ACEi or ARB + CCB + thiazide diuretic. Step 4 — add spironolactone (mineralocorticoid receptor
antagonist) to the three-drug regimen for resistant hypertension. Beta-blockers are NOT first-line for uncomplicated
hypertension — they are reserved for patients with compelling indications (CAD, heart failure). CCBs are avoided in heart failure
or MI. ARBs are avoided in MI and pregnancy. ACE inhibitors are contraindicated in bilateral renal artery stenosis, history of
angioedema, and pregnancy.
,5. Which calcium channel blocker is best for angina?
A. Amlodipine
B. Verapamil — a non-dihydropyridine CCB that reduces heart rate and myocardial oxygen demand
C. Nifedipine
D. Felodipine
CORRECT ANSWER B — Verapamil; non-dihydropyridine CCB; reduces HR and myocardial O2 demand; best for angina
RATIONALE Verapamil is a non-dihydropyridine calcium channel blocker that acts on both vascular smooth muscle AND cardiac muscle. It
reduces heart rate (negative chronotrope), slows AV conduction (negative dromotrope), and decreases myocardial contractility
(negative inotrope) — all of which reduce myocardial oxygen demand, making it the best CCB for ANGINA. Dihydropyridine CCBs
(amlodipine, nifedipine, felodipine — Choices A, C, D) primarily cause vasodilation with less effect on heart rate or contractility.
Important drug interactions: do NOT use verapamil with beta-blockers, digoxin, or diltiazem. Verapamil is contraindicated in
heart failure and should be avoided with beta-blockers due to additive negative inotropic/chronotropic effects.
6. What are the contraindications for ACE inhibitors?
A. Only pregnancy
B. Bilateral renal artery stenosis, history of angioedema, and pregnancy — ACE inhibitors can cause catastrophic renal failure in bilateral
renal artery stenosis and are teratogenic
C. Asthma and COPD
D. No significant contraindications
CORRECT ANSWER B — Bilateral renal artery stenosis, history of angioedema, and pregnancy
RATIONALE ACE inhibitors (lisinopril, enalapril, ramipril, etc.) have three critical contraindications: (1) BILATERAL RENAL ARTERY STENOSIS
— ACE inhibitors block angiotensin II-mediated efferent arteriolar constriction, which is the kidney's compensatory mechanism
to maintain GFR in the setting of renal artery stenosis; without this compensation, GFR drops precipitously, causing acute renal
failure; (2) HISTORY OF ANGIOEDEMA — ACE inhibitors increase bradykinin levels (bradykinin is normally degraded by ACE);
elevated bradykinin can cause life-threatening angioedema of the face, tongue, and airway; (3) PREGNANCY — ACE inhibitors
are teratogenic (FDA Category D), causing renal dysgenesis, oligohydramnios, and fetal death. ARBs (-sartan) have similar
contraindications but do NOT increase bradykinin (thus no cough side effect).
7. Warfarin inhibits which clotting factors?
A. Factors VIII, IX, XI, XII
B. Factors II, VII, IX, and X (the vitamin K-dependent factors) — plus proteins C and S (natural anticoagulants)
C. Only factor Xa
D. Thrombin only
CORRECT ANSWER B — Factors II, VII, IX, X (vitamin K-dependent) + proteins C and S (natural anticoagulants)
RATIONALE Warfarin inhibits vitamin K epoxide reductase, depleting active vitamin K — this prevents gamma-carboxylation of the vitamin
K-dependent clotting factors: II (prothrombin), VII, IX, and X. It ALSO inhibits the natural anticoagulant proteins C and S.
CRITICAL CONCEPT: Because protein C has a shorter half-life than factor II, warfarin causes a TRANSIENT HYPERCOAGULABLE
STATE during the first 5 days of therapy (protein C is depleted before the procoagulant factors). This is why warfarin MUST be
initiated with a fast-acting heparin (LMWH or unfractionated heparin) as "bridge therapy" until the INR is therapeutic. Target
INR: 2–3 for most indications. The NSG 533 emphasizes that warfarin's delayed onset and initial prothrombotic state are
fundamental to safe prescribing.
, 8. What are high-intensity statin therapy doses?
A. Simvastatin 10mg and pravastatin 20mg
B. Atorvastatin 40–80mg and rosuvastatin 20–40mg — these reduce LDL by ≥50%
C. Lovastatin 20mg and fluvastatin 40mg
D. Any statin at any dose is high-intensity
CORRECT ANSWER B — Atorvastatin 40–80mg and rosuvastatin 20–40mg; reduce LDL ≥50%
RATIONALE High-intensity statin therapy reduces LDL cholesterol by ≥50%: Atorvastatin 40–80mg daily OR Rosuvastatin 20–40mg daily.
Moderate-intensity statins (reduce LDL 30–49%): Atorvastatin 10–20mg, Rosuvastatin 5–10mg, Simvastatin 20–40mg,
Pravastatin 40–80mg. Low-intensity statins (reduce LDL <30%): Simvastatin 10mg, Pravastatin 10–20mg, Lovastatin 20mg,
Fluvastatin 20–40mg. High-intensity statins are recommended for: clinical ASCVD, LDL ≥190mg/dL, and diabetic patients aged
40–75 with ASCVD risk factors. The NSG 533 emphasizes matching statin intensity to cardiovascular risk.
9. What is the target INR range for warfarin therapy?
A. 1.0–1.5
B. 2.0–3.0 — this is the target for most indications including atrial fibrillation, DVT/PE treatment, and mechanical heart valves (some
valves require 2.5–3.5)
C. 3.5–4.5
D. 0.5–1.0
CORRECT ANSWER B — INR 2.0–3.0 for most indications; mechanical mitral valves may require 2.5–3.5
RATIONALE Target INR for warfarin: 2.0–3.0 for most indications (atrial fibrillation, DVT/PE treatment and prevention, bioprosthetic heart
valves). Mechanical heart valves (especially mitral) may require a higher target of 2.5–3.5. INR <2.0 = inadequate anticoagulation
→ increased thrombotic risk. INR >3.0 = increased bleeding risk. Warfarin requires regular INR monitoring — initially daily to
weekly, then monthly once stable. The NSG 533 emphasizes that warfarin has a NARROW THERAPEUTIC INDEX — small changes
in diet (vitamin K intake), medications (CYP450 interactions), or health status can significantly alter INR. Patient education
about consistent vitamin K intake and medication interactions is essential.
10. What is the treatment for COPD Classification D (more symptoms, high exacerbation risk)?
A. SABA only
B. LAMA or LAMA+LABA or ICS+LABA — this is the most severe classification requiring maximal bronchodilation ± ICS
C. No pharmacotherapy needed
D. Oral corticosteroids only
CORRECT ANSWER B — LAMA or LAMA+LABA or ICS+LABA for Group D (most severe COPD)
RATIONALE COPD GOLD guidelines classify patients by symptom burden and exacerbation risk: Group A (few symptoms, low risk) — SABA.
Group B (more symptoms, low risk) — LABA or LAMA. Group C (few symptoms, high risk) — LAMA. Group D (more symptoms,
high risk) — LAMA, or LAMA+LABA, or ICS+LABA (if blood eosinophils ≥300 or history of frequent exacerbations). Roflumilast
(phosphodiesterase-4 inhibitor) may be added for chronic bronchitis with frequent exacerbations — side effects include weight
loss, diarrhea, and depression. The NSG 533 emphasizes the ABCD assessment tool for matching COPD treatment intensity to
disease severity.
3 MAXE · 335 GSN
W
Passan School of Nursing
EST. 1933
UNITY AMIDST DIVERSITY
NSG 533 Exam 3
R E S P I RATO RY, C A R D I OVA S CU L A R , L I P I D & A N T I COAG U L AT I O N P H A R M ACO LO G Y
INSTITUTION Wilkes University COURSE CODE NSG 533
PROGRAM Advanced Pharmacology — Graduate Nursing EXAM Exam 3 — Respiratory, CV, Anticoagulation
EXAM TITLE NSG 533 Exam 3 TOTAL QUESTIONS 65 Questions
COURSE TITLE Advanced Pharmacology FORMAT Multiple Choice — Select the Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Asthma (ICS, LABAs, LAMAs, biologics), COPD GOLD guidelines, hypertension treatment algorithm, statins, lipid-lowering agents, anticoagulation
(warfarin, heparin, NOACs), and antiplatelet therapy are all testable content.
▸ Correct answers and clinical rationales appear below each question.
▸ All content reflects NSG 533 Advanced Pharmacology course objectives.
SECTION I — RESPIRATORY, CARDIOVASCULAR & ANTICOAGULATION PHARMACOLOGY Questions 1 – 65
1. What are the symptoms of uncontrolled asthma?
A. Only nighttime symptoms
B. At least three of: daytime asthma >2x/week, nighttime awakening, reliever therapy >2x/week, and activity intolerance
C. Only activity limitation
D. Any single asthma symptom regardless of frequency
CORRECT ANSWER B — At least three: daytime symptoms >2x/week, nighttime awakening, reliever >2x/week, activity limitation
RATIONALE Uncontrolled asthma is defined by the presence of at least THREE of the following: (1) daytime asthma symptoms more than
twice a week; (2) nighttime awakening due to asthma; (3) reliever (rescue) therapy needed more than twice a week; (4) activity
limitation due to asthma. These criteria guide treatment escalation according to the stepwise approach. For symptoms
<2x/month: as-needed low-dose ICS-formoterol or as-needed low-dose ICS with SABA. For symptoms >2x/month: daily low-
dose ICS and as-needed SABA. For symptoms most days: daily low-dose ICS-formoterol and as-needed SABA or daily medium-
dose ICS. For severe daily symptoms: daily medium-dose ICS-formoterol with reliever or daily high-dose ICS with reliever.
,2. What is the treatment for asthma symptoms occurring less than twice a month?
A. Daily high-dose ICS with LABA
B. As-needed low-dose ICS-formoterol OR as-needed low-dose ICS with SABA
C. Daily oral corticosteroids
D. No treatment is needed
CORRECT ANSWER B — As-needed low-dose ICS-formoterol or as-needed low-dose ICS with SABA
RATIONALE For the mildest asthma (symptoms <2x/month), current guidelines recommend AS-NEEDED therapy: either low-dose ICS-
formoterol (budesonide-formoterol/Symbicort) as both maintenance and reliever, OR low-dose ICS used concomitantly with as-
needed SABA. This represents a shift from older guidelines that recommended SABA-only for mild intermittent asthma — ICS is
now recommended even for mild asthma because it addresses the underlying airway inflammation, not just
bronchoconstriction. The NSG 533 emphasizes the GINA (Global Initiative for Asthma) stepwise approach: treatment intensity
increases with symptom frequency and severity.
3. Which beta-blockers are contraindicated in asthma?
A. Metoprolol and atenolol
B. Nadolol, propranolol, timolol, and sotalol — these are non-selective beta-blockers that can cause bronchoconstriction
C. All beta-blockers are safe in asthma
D. Only labetalol
CORRECT ANSWER B — Nadolol, propranolol, timolol, sotalol (non-selective beta-blockers); cause bronchoconstriction
RATIONALE Non-selective beta-blockers (nadolol, propranolol, timolol, sotalol) block BOTH beta-1 (cardiac) and beta-2 (bronchial)
receptors — beta-2 blockade causes BRONCHOCONSTRICTION and can precipitate severe asthma exacerbations. These agents
are CONTRAINDICATED in patients with asthma or bronchospastic conditions. Cardioselective beta-1 blockers (metoprolol,
atenolol, bisoprolol — Choice A) have relative selectivity for cardiac beta-1 receptors and may be used with CAUTION in asthma
if absolutely necessary, though they still carry some risk at higher doses. The NSG 533 emphasizes that beta-blocker selection in
patients with respiratory disease requires careful consideration of cardioselectivity.
4. What is the hypertension treatment algorithm (Steps 1–4)?
A. Start with two agents for all patients
B. Step 1: ACEi/ARB/CCB/thiazide; Step 2: ACEi/ARB + CCB/thiazide; Step 3: ACEi/ARB + CCB + thiazide; Step 4: ACEi/ARB + CCB + thiazide +
spironolactone
C. Step 1: beta-blocker; Step 2: beta-blocker + diuretic; Step 3: triple therapy
D. Only lifestyle modifications for all stages
CORRECT ANSWER B — Step 1: ACEi/ARB/CCB/thiazide; Step 2: ACEi/ARB + CCB/thiazide; Step 3: ACEi/ARB + CCB + thiazide; Step 4: add
spironolactone
RATIONALE The current hypertension treatment algorithm follows four steps: Step 1 — monotherapy with ACE inhibitor, ARB, calcium
channel blocker (CCB), or thiazide diuretic. Step 2 — two-drug combination: ACEi or ARB + CCB or thiazide diuretic. Step 3 —
three-drug combination: ACEi or ARB + CCB + thiazide diuretic. Step 4 — add spironolactone (mineralocorticoid receptor
antagonist) to the three-drug regimen for resistant hypertension. Beta-blockers are NOT first-line for uncomplicated
hypertension — they are reserved for patients with compelling indications (CAD, heart failure). CCBs are avoided in heart failure
or MI. ARBs are avoided in MI and pregnancy. ACE inhibitors are contraindicated in bilateral renal artery stenosis, history of
angioedema, and pregnancy.
,5. Which calcium channel blocker is best for angina?
A. Amlodipine
B. Verapamil — a non-dihydropyridine CCB that reduces heart rate and myocardial oxygen demand
C. Nifedipine
D. Felodipine
CORRECT ANSWER B — Verapamil; non-dihydropyridine CCB; reduces HR and myocardial O2 demand; best for angina
RATIONALE Verapamil is a non-dihydropyridine calcium channel blocker that acts on both vascular smooth muscle AND cardiac muscle. It
reduces heart rate (negative chronotrope), slows AV conduction (negative dromotrope), and decreases myocardial contractility
(negative inotrope) — all of which reduce myocardial oxygen demand, making it the best CCB for ANGINA. Dihydropyridine CCBs
(amlodipine, nifedipine, felodipine — Choices A, C, D) primarily cause vasodilation with less effect on heart rate or contractility.
Important drug interactions: do NOT use verapamil with beta-blockers, digoxin, or diltiazem. Verapamil is contraindicated in
heart failure and should be avoided with beta-blockers due to additive negative inotropic/chronotropic effects.
6. What are the contraindications for ACE inhibitors?
A. Only pregnancy
B. Bilateral renal artery stenosis, history of angioedema, and pregnancy — ACE inhibitors can cause catastrophic renal failure in bilateral
renal artery stenosis and are teratogenic
C. Asthma and COPD
D. No significant contraindications
CORRECT ANSWER B — Bilateral renal artery stenosis, history of angioedema, and pregnancy
RATIONALE ACE inhibitors (lisinopril, enalapril, ramipril, etc.) have three critical contraindications: (1) BILATERAL RENAL ARTERY STENOSIS
— ACE inhibitors block angiotensin II-mediated efferent arteriolar constriction, which is the kidney's compensatory mechanism
to maintain GFR in the setting of renal artery stenosis; without this compensation, GFR drops precipitously, causing acute renal
failure; (2) HISTORY OF ANGIOEDEMA — ACE inhibitors increase bradykinin levels (bradykinin is normally degraded by ACE);
elevated bradykinin can cause life-threatening angioedema of the face, tongue, and airway; (3) PREGNANCY — ACE inhibitors
are teratogenic (FDA Category D), causing renal dysgenesis, oligohydramnios, and fetal death. ARBs (-sartan) have similar
contraindications but do NOT increase bradykinin (thus no cough side effect).
7. Warfarin inhibits which clotting factors?
A. Factors VIII, IX, XI, XII
B. Factors II, VII, IX, and X (the vitamin K-dependent factors) — plus proteins C and S (natural anticoagulants)
C. Only factor Xa
D. Thrombin only
CORRECT ANSWER B — Factors II, VII, IX, X (vitamin K-dependent) + proteins C and S (natural anticoagulants)
RATIONALE Warfarin inhibits vitamin K epoxide reductase, depleting active vitamin K — this prevents gamma-carboxylation of the vitamin
K-dependent clotting factors: II (prothrombin), VII, IX, and X. It ALSO inhibits the natural anticoagulant proteins C and S.
CRITICAL CONCEPT: Because protein C has a shorter half-life than factor II, warfarin causes a TRANSIENT HYPERCOAGULABLE
STATE during the first 5 days of therapy (protein C is depleted before the procoagulant factors). This is why warfarin MUST be
initiated with a fast-acting heparin (LMWH or unfractionated heparin) as "bridge therapy" until the INR is therapeutic. Target
INR: 2–3 for most indications. The NSG 533 emphasizes that warfarin's delayed onset and initial prothrombotic state are
fundamental to safe prescribing.
, 8. What are high-intensity statin therapy doses?
A. Simvastatin 10mg and pravastatin 20mg
B. Atorvastatin 40–80mg and rosuvastatin 20–40mg — these reduce LDL by ≥50%
C. Lovastatin 20mg and fluvastatin 40mg
D. Any statin at any dose is high-intensity
CORRECT ANSWER B — Atorvastatin 40–80mg and rosuvastatin 20–40mg; reduce LDL ≥50%
RATIONALE High-intensity statin therapy reduces LDL cholesterol by ≥50%: Atorvastatin 40–80mg daily OR Rosuvastatin 20–40mg daily.
Moderate-intensity statins (reduce LDL 30–49%): Atorvastatin 10–20mg, Rosuvastatin 5–10mg, Simvastatin 20–40mg,
Pravastatin 40–80mg. Low-intensity statins (reduce LDL <30%): Simvastatin 10mg, Pravastatin 10–20mg, Lovastatin 20mg,
Fluvastatin 20–40mg. High-intensity statins are recommended for: clinical ASCVD, LDL ≥190mg/dL, and diabetic patients aged
40–75 with ASCVD risk factors. The NSG 533 emphasizes matching statin intensity to cardiovascular risk.
9. What is the target INR range for warfarin therapy?
A. 1.0–1.5
B. 2.0–3.0 — this is the target for most indications including atrial fibrillation, DVT/PE treatment, and mechanical heart valves (some
valves require 2.5–3.5)
C. 3.5–4.5
D. 0.5–1.0
CORRECT ANSWER B — INR 2.0–3.0 for most indications; mechanical mitral valves may require 2.5–3.5
RATIONALE Target INR for warfarin: 2.0–3.0 for most indications (atrial fibrillation, DVT/PE treatment and prevention, bioprosthetic heart
valves). Mechanical heart valves (especially mitral) may require a higher target of 2.5–3.5. INR <2.0 = inadequate anticoagulation
→ increased thrombotic risk. INR >3.0 = increased bleeding risk. Warfarin requires regular INR monitoring — initially daily to
weekly, then monthly once stable. The NSG 533 emphasizes that warfarin has a NARROW THERAPEUTIC INDEX — small changes
in diet (vitamin K intake), medications (CYP450 interactions), or health status can significantly alter INR. Patient education
about consistent vitamin K intake and medication interactions is essential.
10. What is the treatment for COPD Classification D (more symptoms, high exacerbation risk)?
A. SABA only
B. LAMA or LAMA+LABA or ICS+LABA — this is the most severe classification requiring maximal bronchodilation ± ICS
C. No pharmacotherapy needed
D. Oral corticosteroids only
CORRECT ANSWER B — LAMA or LAMA+LABA or ICS+LABA for Group D (most severe COPD)
RATIONALE COPD GOLD guidelines classify patients by symptom burden and exacerbation risk: Group A (few symptoms, low risk) — SABA.
Group B (more symptoms, low risk) — LABA or LAMA. Group C (few symptoms, high risk) — LAMA. Group D (more symptoms,
high risk) — LAMA, or LAMA+LABA, or ICS+LABA (if blood eosinophils ≥300 or history of frequent exacerbations). Roflumilast
(phosphodiesterase-4 inhibitor) may be added for chronic bronchitis with frequent exacerbations — side effects include weight
loss, diarrhea, and depression. The NSG 533 emphasizes the ABCD assessment tool for matching COPD treatment intensity to
disease severity.
