# PLAB 1 Asthma Questions: 10 Free Practice MCQs > 10 free PLAB 1 asthma questions with answers and explanations, from a bank of 47 asthma questions. Try them now, no sign up. Canonical: https://medhub.one/practice/plab-1/asthma Last updated: 2026-10-31 Asthma questions test the stepwise approach and the acute attack. The MLA content map expects objective confirmation of variable airflow obstruction, correct inhaler technique, adherence review and a written action plan. In acute asthma the marks are for oxygen, bronchodilators, steroids and the decision to escalate, and for recognising the silent chest and exhaustion that signal imminent respiratory arrest. ## Where candidates lose marks * Stepping up treatment without checking adherence and inhaler technique. * Using a long acting beta agonist without inhaled corticosteroid in asthma. * Failing to give systemic steroids early in an acute attack. * Missing the life threatening features: silent chest, cyanosis, exhaustion and a normal or rising carbon dioxide. **Guideline to follow:** PLAB 1 follows the joint BTS, SIGN and NICE asthma guideline and the BTS SIGN British guideline on the management of asthma. Ten PLAB 1-style asthma questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 47 asthma questions and many more across every topic. [Free timed mock exam](https://medhub.one/practice/plab-1/mock) 1. 1 / 10 A 27-year-old with asthma attends a review and finds it difficult to describe how often symptoms wake them or limit activity. The clinician is considering a structured way to assess control. Which tool may be considered at an asthma review? Show answer **Answer: B.** A validated symptom questionnaire such as the Asthma Control Test **Why:** Consider a validated symptom questionnaire at an asthma review, such as the Asthma Control Questionnaire, Asthma Control Test or Childhood Asthma Control Test. It can support the discussion but should be considered alongside other control and risk information. * **A.** NICE NG245 does not recommend regular peak flow monitoring for all people to assess control. * **C.** A chest radiograph is not the validated symptom questionnaire described in the guideline. * **D.** Brand preference alone does not measure asthma control; use a validated symptom questionnaire if helpful. Sources: BTS NICE SIGN NG245 recommendation 1.5.2 2. 2 / 10 A 4-year-old improved during an inhaled corticosteroid trial, but symptoms returned by the 3 month review. The child has not yet had a further severe episode. What treatment approach is recommended? Show answer **Answer: B.** Restart regular paediatric low-dose ICS with SABA as needed and titrate to a moderate dose if needed **Why:** Restart regular inhaled corticosteroid at a paediatric low dose with SABA as needed because symptoms recurred by the 3-month review. NICE NG245 advises titrating to a paediatric moderate dose if needed and considering a further trial without treatment after review within 12 months. This is not an adult MART pathway. * **A.** Restarting at low dose is appropriate, but NICE allows titration to a paediatric moderate dose if needed when symptoms recur by the 3-month review. * **C.** An adult MART regimen is not recommended for this under-5 scenario; use age-appropriate regular paediatric ICS with SABA as needed. * **D.** Recurrence after stopping the successful trial supports restarting regular ICS rather than avoiding inhaled treatment. Sources: BTS NICE SIGN NG245 recommendation 1.9.4 3. 3 / 10 A 35-year-old with asthma uses low-dose inhaled corticosteroid (ICS) daily and salbutamol as needed. Despite confirmed adherence and correct inhaler technique, they have symptoms three times a week and wake with cough once a week. No new exposure or comorbidity is identified. What is the next step in his maintenance treatment pathway according to NICE guidelines? Show answer **Answer: A.** Change to low-dose maintenance and reliever therapy (MART) with an ICS/formoterol inhaler **Why:** NICE NG245 recommendation 1.6.1 says to address possible causes of poor control, including adherence, inhaler technique, smoking, exposures, comorbidities and psychosocial factors, before adjusting treatment. Recommendation 1.7.8 advises considering a change to low-dose MART for people aged 12 and over whose asthma is not controlled on regular low-dose ICS plus SABA as needed. MART uses an ICS/formoterol inhaler for maintenance and symptom relief. The former NG80 step that placed an LTRA before a LABA is not the current pathway. * **B.** NG245 does not specify adding an LTRA as the routine next step from this legacy regimen; it advises considering a change to low-dose MART. * **C.** Increasing the old ICS regimen without first checking adherence, inhaler technique and other causes of poor control skips the assessment recommended by NG245. * **D.** A LAMA is not the recommended direct change from low-dose ICS plus SABA; NG245 considers add-on LAMA trials later for asthma uncontrolled on moderate-dose MART. Sources: BTS, NICE and SIGN NG245 recommendations 1.6.1 and 1.7.8 4. Like these? UK.med has a bank of 1999 questions, plus timed mock exams. Free to start: [App Store](https://apps.apple.com/app/id6760537451?utm%5Fsource=medhub.one&utm%5Fmedium=owned%5Fweb&utm%5Fcampaign=practice&utm%5Fcontent=plab-1) · [Google Play](https://play.google.com/store/apps/details?id=com.medicinahub.ukmed&utm%5Fsource=medhub.one&utm%5Fmedium=owned%5Fweb&utm%5Fcampaign=practice&utm%5Fcontent=plab-1) 5. 4 / 10 A 4-year-old remains symptomatic during an 8 to 12 week inhaled corticosteroid trial for suspected asthma. There is no clear improvement so far. What should be checked before referral? Show answer **Answer: B.** Inhaler technique and adherence, environmental exposures and whether another diagnosis is likely **Why:** If symptoms do not resolve during the trial, first check inhaler technique and adherence, assess for environmental sources such as mould, cold housing, smokers or indoor pollution, and review whether an alternative diagnosis is likely. If none explains the response, refer to an asthma specialist. * **A.** NICE NG245 recommends checking technique, adherence, environmental sources and alternative diagnoses first. * **C.** NICE NG245 recommends evaluating why symptoms persist and referral if the checks do not explain it. * **D.** The guideline's first steps are technique, adherence, environment and alternative diagnosis, not routine CT. Sources: BTS NICE SIGN NG245 recommendation 1.9.2 6. 5 / 10 A 36-year-old with newly diagnosed asthma presents with regular nocturnal waking and a severe exacerbation. What initial asthma regimen should be started alongside acute care? Show answer **Answer: A.** Low dose MART, with treatment for the acute symptoms as indicated. **Why:** NICE NG245 recommends low dose MART for highly symptomatic people or those presenting with a severe exacerbation, alongside acute treatment as indicated. The remaining options use the wrong threshold, omit a required step, or move to a later test or treatment before the recommended step for this presentation. * **B.** The guideline recommends regular maintenance plus reliever treatment in this situation. * **C.** Moderate dose MART is not the specified initial step. * **D.** SABA alone omits anti inflammatory treatment. Sources: NICE NG245 recommendation 1.7.2 7. 6 / 10 A 25-year-old has newly diagnosed asthma and is not highly symptomatic or presenting with a severe exacerbation. What initial reliever treatment should be offered? Show answer **Answer: D.** A low dose ICS/formoterol combination inhaler as needed for symptom relief. **Why:** NICE NG245 recommends as needed low dose ICS/formoterol AIR therapy for people aged 12 and over with newly diagnosed asthma. The remaining options use the wrong threshold, omit a required step, or move to a later test or treatment before the recommended step for this presentation. * **A.** SABA alone is not the recommended initial strategy in NG245. * **B.** High dose MART is not recommended for all newly diagnosed people. * **C.** Regular oral steroids are not initial chronic therapy. Sources: NICE NG245 recommendation 1.7.1 8. 7 / 10 A 34-year-old with asthma attends a routine review. They say symptoms are manageable, but the prescription record shows frequent reliever inhaler use and they missed several work shifts. What should be checked when monitoring asthma control? Show answer **Answer: A.** Symptoms, time off work or school, reliever use, oral steroid courses and hospital or emergency visits **Why:** At each review, monitor asthma control by asking about symptoms and checking time off work or school, reliever inhaler use including prescription records, oral corticosteroid courses and hospital admissions or emergency department visits. These indicators can reveal poor control even when the person describes symptoms as manageable. * **B.** Symptoms are important, but NICE NG245 also lists reliever use, time off, steroid courses and urgent care. * **C.** A prior lung function test does not replace monitoring current control and exacerbation history. * **D.** Possession of a meter does not assess the range of control indicators recommended by NICE. Sources: BTS NICE SIGN NG245 recommendation 1.5.1 9. 8 / 10 A 45-year-old with asthma has requested 3 SABA inhalers in the last year but has not yet needed oral corticosteroids or hospital care. The practice is reviewing risk factors for poor outcomes. Does this inhaler use meet a NICE NG245 risk factor? Show answer **Answer: C.** Yes, use of more than 2 SABA inhalers in a year is a risk factor **Why:** Consider actively identifying people at risk of poor asthma outcomes. NICE NG245 includes non adherence, use of more than 2 SABA inhalers per year, 2 or more courses of oral corticosteroids per year, 2 or more emergency department visits, or any hospital admission for asthma. * **A.** NICE NG245 uses more than 2 SABA inhalers per year as a risk factor, so 3 meets the threshold. * **B.** NICE NG245 lists several risk factors, including SABA overuse, oral steroid courses and emergency visits. * **D.** The recommendation uses a threshold above 2 SABA inhalers per year, not one inhaler. Sources: BTS NICE SIGN NG245 recommendation 1.15.1 10. 9 / 10 A 10-year-old with asthma needs separate preventer and reliever inhalers. They sometimes struggle to activate their dry powder inhaler during an acute attack. Which device plan may be appropriate? Show answer **Answer: A.** If possible, use the same type of device for preventer and reliever and consider an extra metered dose inhaler with spacer for emergencies **Why:** If possible, prescribe the same type of device for preventer and reliever treatment when more than one inhaler is needed. For a child under 12 who may be unable to activate a dry powder inhaler during an acute attack, consider an additional metered dose SABA inhaler with spacer for emergency use. * **B.** NICE NG245 says to use the same type of device where possible when more than one inhaler is needed. * **C.** The recommendation does not advise removing reliever treatment; it addresses suitable device delivery. * **D.** An additional metered dose SABA inhaler with spacer may be considered when a child cannot activate a dry powder device in an attack. Sources: BTS NICE SIGN NG245 recommendation 1.6.8 11. 10 / 10 A 3-year-old with suspected asthma has had severe episodes of wheeze and difficulty breathing, including one hospital admission. The family asks whether a maintenance treatment trial is appropriate. Which approach may be considered? Show answer **Answer: A.** An 8 to 12 week trial of twice daily paediatric low dose ICS with SABA for relief **Why:** For children under 5 with suspected asthma and severe acute episodes of difficulty breathing and wheeze, such as an episode requiring hospital admission, NICE NG245 recommends considering an 8 to 12 week trial of twice daily paediatric low dose inhaled corticosteroid with SABA for relief. * **B.** NICE NG245 includes selected children under 5 with suspected asthma in its empirical trial recommendation. * **C.** The recommendation is for a time limited low dose trial and reassessment, not automatic permanent high dose treatment. * **D.** For the initial trial described in recommendation 1.9.1, NICE specifies low dose ICS with SABA for relief. Sources: BTS NICE SIGN NG245 recommendation 1.9.1 ## Explore the 1999-question bank in UK.med Timed practice, spaced repetition and AI clinical simulations that grade you like an examiner. Free to start. 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