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Primary membranous nephropathy — ABIM Board MCQ

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HardNephrologyPrimary membranous nephropathyABIM Board

A 34-year-old woman with asthma uses medium-dose budesonide-formoterol twice daily as maintenance-and-reliever therapy. She develops wheeze after exercise. Which rescue inhaler strategy is consistent with this regimen?

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Correct answer: EUse budesonide-formoterol as needed within the daily dose limit

The best answer is “Use budesonide-formoterol as needed within the daily dose limit”. SMART uses ICS-formoterol for both scheduled maintenance and rapid relief because formoterol has a rapid onset. The same inhaler may therefore be used for breakthrough symptoms within regimen-specific dose limits. Salmeterol and tiotropium are not rescue agents, and withholding maintenance doses undermines control.

Reference: NHLBI 2020 Focused Updates to the Asthma Management Guidelines: https://www.nhlbi.nih.gov/sites/default/files/publications/AsthmaManagementGuidelinesReport-2-4-21.pdf