Respiratory High-Yield: Asthma, COPD, and Pneumonia for FNP Boards

Clinical High-Yield · 9 min read · March 6, 2026

Asthma: The Essentials

Diagnosis: Episodic symptoms + reversible airflow obstruction on spirometry (FEV1/FVC <0.70 that improves ≥12% with bronchodilator)

Classification and treatment (GINA stepwise):

• Intermittent: SABA PRN only
• Mild persistent: Low-dose ICS
• Moderate persistent: Low-dose ICS + LABA
• Severe persistent: Medium/high-dose ICS + LABA ± additional controller

Board pearls:

• SABA (albuterol) is rescue; ICS is controller — never use LABA alone without ICS
• Montelukast is an alternative controller for mild persistent asthma
• Magnesium sulfate IV for severe exacerbations not responding to standard treatment
• Avoid beta-blockers in asthma (can precipitate bronchospasm)

COPD: The Essentials

Diagnosis: Spirometry showing FEV1/FVC <0.70 post-bronchodilator in a patient with risk factors (smoking, occupational exposure)

GOLD classification (by FEV1):

• GOLD 1 (mild): FEV1 ≥80%
• GOLD 2 (moderate): 50–79%
• GOLD 3 (severe): 30–49%
• GOLD 4 (very severe): <30%

Treatment (stepwise by symptoms and exacerbation risk):

• All patients: Smoking cessation, influenza vaccine, pneumococcal vaccine
• Low risk, few symptoms: SABA PRN
• Low risk, more symptoms: LAMA (tiotropium) or LABA
• High risk: LAMA + LABA ± ICS

Board pearls:

• LAMA (tiotropium) is preferred over LABA as first controller in COPD
• ICS is added for frequent exacerbations, not as first-line
• Supplemental oxygen if resting SpO2 ≤88% (reduces mortality)
• Pulmonary rehab reduces hospitalizations and improves quality of life

Asthma vs. COPD: Key Distinctions

Feature	Asthma	COPD
Age of onset	Usually <40	Usually >40
Smoking history	Not required	Almost always present
Airflow obstruction	Reversible	Partially reversible
Symptoms	Episodic	Progressive
Eosinophilia	Common	Less common

Pneumonia: Community-Acquired (CAP)

Diagnosis: New infiltrate on CXR + ≥2 of: fever, cough, sputum production, pleuritic chest pain, dyspnea, crackles on exam

Outpatient treatment (no comorbidities):

• Amoxicillin 1g TID x5 days OR
• Doxycycline 100mg BID x5 days OR
• Azithromycin (if low resistance rates in community)

Outpatient treatment (with comorbidities — DM, CKD, liver disease, immunosuppression):

• Respiratory fluoroquinolone (levofloxacin, moxifloxacin) OR
• Beta-lactam + macrolide

Hospitalization criteria (CURB-65):

• Confusion (new)
• Urea >19 mg/dL
• Respiratory rate ≥30
• BP <90/60
• Age ≥65
• Score 0–1: Outpatient; Score 2: Consider hospitalization; Score ≥3: Hospitalize

Board pearl: Atypical organisms (Mycoplasma, Chlamydophila, Legionella) cause "walking pneumonia" — gradual onset, dry cough, minimal fever. Treat with macrolide or doxycycline.