Is respiratory high yield on the PEBC exam?

Yes. Asthma, COPD, allergic rhinitis, and smoking cessation are core community-practice topics, so they come up often. The exact mix is randomized from one sitting to the next, but respiratory is consistently worth strong preparation, especially inhaler selection and technique.

What respiratory topics should I focus on for the PEBC?

Focus on asthma step therapy, COPD management and exacerbations, inhaler selection and technique, allergic rhinitis, and smoking cessation. Knowing the step-up and step-down logic and the role of each inhaler class matters more than memorizing every product name.

Which guidelines should I use for respiratory on the PEBC?

The Canadian standard references are the Canadian Thoracic Society (CTS) guidelines for asthma and COPD, and the GINA strategy for asthma. The PEBC expects the Canadian approach to step therapy and inhaler selection, so study from CTS rather than from a US source.

How should I study respiratory for the PEBC?

Learn the asthma and COPD step approaches, the inhaler classes and what each does, and how to counsel on inhaler technique. Then read each vignette for the control level or patient factor that changes the answer.

PEBC Respiratory Practice Questions

Respiratory is a high-yield area on the PEBC exam, and a very practical one for community practice. Asthma, COPD, allergic rhinitis, and smoking cessation all show up, and most questions test the step-up or step-down decision and the right inhaler for the patient.

The questions below sample each of those areas. The explanations work through all four options and land on the control level or the patient factor that separates the right call from the tempting one.

Independent PEBC-style practice, grounded in Canadian references and not official PEBC exam content.

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All 4

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How to approach a PEBC respiratory question

1For asthma and COPD, identify the control or severity level first, then pick the step. Most questions test a step-up or step-down decision.
2Know the inhaler classes and what each one does: SABA, ICS, LABA, and LAMA, and when combination therapy is appropriate.
3Anchor on the Canadian Thoracic Society (CTS) guidance, and for asthma the GINA strategy, since the exam expects the Canadian standard.
4Watch for inhaler technique and counselling questions. They are common, high yield, and exactly what a community pharmacist is expected to know.
5For smoking cessation, match the agent (nicotine replacement, varenicline, or bupropion) to the patient and know the contraindications.

Practice questions

Tap an answer to see why each option is right or wrong.

Question 1Smoking Cessation

TL is a 47 year old male who smokes 22 cigarettes per day. He is motivated to quit and agrees to start NRT. Which of the following is the most appropriate initial patch regimen?

Incorrect · Answer: B

PEBC Yield: Highdrug-selectiondose-adjustment

Incorrect. The 7 mg patch is the lowest step-down dose and would be inadequate for a patient smoking 22 CPD. It is used during the tapering phase.

B) (Correct)

Correct. For patients smoking 10-29 CPD, the recommended starting patch dose is 21 mg daily. A short-acting NRT product should also be added for breakthrough cravings.

Incorrect. A 28 mg combined patch (21 mg + 7 mg) is reserved for patients smoking more than 30 CPD. This patient smokes 22 CPD.

Incorrect. The 14 mg patch is recommended for patients smoking fewer than 10 CPD. This patient smokes 22 CPD and requires a higher dose.

Question 2Allergic Rhinitis

BR is a 35-year-old male with perennial allergic rhinitis switched from diphenhydramine to loratadine 10 mg orally once daily because of daytime sedation. He asks the pharmacist about the side effect profile of loratadine compared with first-generation agents. Which comparison is most accurate?

Incorrect · Answer: D

PEBC Yield: Highadverse-effectantihistamineallergic-rhinitisloratadinecomparison

Tempting because all H1 antagonists share the same target. Wrong here because second-generation agents penetrate the blood-brain barrier far less than first-generation, producing markedly less sedation. Would never be correct as a comparison.

Tempting because both generations block H1 receptors. Wrong here because second-generation agents have substantially fewer anticholinergic effects than first-generation. Would be correct only if the agents were chemically equivalent.

Tempting because anticholinergic dry mouth is a common antihistamine side effect. Wrong here because dry mouth is a first-generation effect, not a feature of second-generation loratadine. Would be correct for diphenhydramine.

D) (Correct)

Correct -- second-generation antihistamines including loratadine have significantly less CNS penetration and fewer anticholinergic effects than first-generation agents. Some sedation is still possible at high-dose cetirizine, but the class profile is favorable.

Question 3Asthma

TR is a 34 year old male with asthma experiencing daytime symptoms most days of the week and nocturnal awakenings twice per week. Spirometry shows FEV1 at 72% predicted. He is currently on budesonide-formoterol 200/6 mcg 1 inhalation PRN. Which of the following is the most appropriate adjustment to his therapy?

Incorrect · Answer: D

PEBC Yield: Highstepwise-therapytreatment-adjustment

Continuing PRN-only therapy does not address persistent symptoms most days of the week with twice-weekly nocturnal awakenings — these signs indicate the patient needs a controller regimen (Step 3).

Tiotropium is a Step 5 add-on (after maintenance ICS-LABA), not first-line at Step 3, and is not used as sole controller in asthma.

Budesonide-formoterol 2 inhalations BID maintenance plus PRN is a medium-dose MART regimen — this exceeds the recommended Step 3 dose of low-dose MART; reserved for Step 4.

D) (Correct)

Correct. Low-dose MART — budesonide-formoterol 1 inhalation BID maintenance plus PRN — is GINA's preferred Step 3 regimen for adults with daily symptoms, nocturnal awakenings ≥1 per week, or low lung function. Per CTS, this is the preferred bud/form-based controller at this severity tier.

Question 4Allergic Rhinitis

MZ is a 36-year-old female with allergic rhinitis and concomitant mild persistent asthma on a low-dose ICS, started on intranasal ciclesonide. Which symptom set is improved by the intranasal corticosteroid?

Incorrect · Answer: D

PEBC Yield: Highdrug-selectionincsallergic-rhinitisasthmasymptom-coverage

Nasal congestion and rhinorrhea response captures part of the benefit but understates the additional ocular and lower-airway coverage relevant to this patient.

Conjunctival itch and tearing improvement is a real secondary effect of intranasal corticosteroids but does not capture the full symptom set in a patient with concomitant asthma.

Wheeze and lower-airway cough response is a secondary benefit and not the primary indication of an intranasal corticosteroid taken alone.

D) (Correct)

Correct. Intranasal corticosteroids improve nasal congestion and rhinorrhea, reduce ocular allergy symptoms, and provide additional lower-airway benefit in patients with concomitant asthma through reduced upper- and lower-airway inflammation.

Question 5Allergic Rhinitis

AS is a 35-year-old male with year-round nasal congestion that worsens at home but improves on vacation. He has two indoor cats and lives in a carpeted basement apartment. Which allergen pattern most characterizes perennial allergic rhinitis?

Incorrect · Answer: B

PEBC Yield: Highdiagnosisallergensallergic-rhinitisperennialindoor

Tree and grass pollens released seasonally drive seasonal, not perennial, allergic rhinitis.

B) (Correct)

Correct. Perennial allergic rhinitis is characterized by year-round indoor allergens such as dust mites, animal dander, and cockroach proteins, which match this patient's home environment with two indoor cats and a carpeted basement.

Ragweed and birch are seasonal outdoor pollens responsible for spring and late-summer flares rather than year-round symptoms.

Insect stings and ingested food proteins cause systemic allergic reactions, not the chronic upper-airway picture of perennial allergic rhinitis.

Question 6Asthma

KL, a 42-year-old male, is using budesonide 600 mcg/day via Turbuhaler for asthma. His physician asks you to classify his current ICS dose. This dose is classified as which of the following for an adult?

Incorrect · Answer: A

PEBC Yield: Highdose-optimizationICS-dosing

A) (Correct)

Correct. For adults, medium-dose budesonide is defined as 400-800 mcg/day. At 600 mcg/day, this patient falls within the medium-dose range.

Incorrect. High-dose budesonide in adults is greater than 800 mcg/day. The patient's 600 mcg/day dose does not reach this threshold.

Incorrect. Low-dose budesonide in adults is less than 400 mcg/day. At 600 mcg/day, this patient exceeds the low-dose threshold.

Incorrect. This is not a recognized ICS dosing classification. The three categories are low, medium, and high dose.

Question 7COPD

A pharmacist is reviewing a continuing education module on AECOPD. Which of the following statements about the infectious causes of acute exacerbations of COPD is correct?

Incorrect · Answer: D

PEBC Yield: Highpathogen-coverageempiric-therapy

Atypical pathogens such as Mycoplasma or Chlamydia can occasionally cause exacerbations but are not the predominant infectious etiology in AECOPD.

Fungal infections are not a recognized common cause of AECOPD. Fungal pathogens are more relevant in immunocompromised patients or those on prolonged systemic corticosteroids.

Bacterial infections (S. pneumoniae, H. influenzae, M. catarrhalis) are important causes but are not the most common infectious trigger. Antibiotics are only indicated when bacterial infection is suspected based on cardinal symptoms.

D) (Correct)

Correct -- viruses are the most common infectious agent in COPD exacerbations. This is why antibiotics are not automatically indicated for every AECOPD and require meeting 2-3 of the Anthonisen criteria before initiation.

Question 8Asthma

BN is a 30-year-old pregnant female at 28 weeks gestation. She has moderate persistent asthma well controlled on medium-dose fluticasone/salmeterol. She asks if she should reduce her asthma medications given concerns about effects on the baby. Which of the following is the most appropriate recommendation?

Incorrect · Answer: D

PEBC Yield: Highdrug-selectioncounselling

Stepping down to low-dose ICS and stopping LABA constitutes a step-down during pregnancy, which is contraindicated.

Switching to budesonide-formoterol MART introduces unnecessary regimen change in a well-controlled patient; though budesonide is the preferred ICS in pregnancy, destabilizing a controlled regimen is risky.

Discontinuing LABA is also a step-down move that risks loss of control during pregnancy.

D) (Correct)

Correct. Asthma therapy is not stepped down during pregnancy; both ICS and LABA are considered acceptable, and her current well-controlled regimen should be maintained to protect both maternal control and fetal outcomes.

Question 9COPD

RK, a 63-year-old female with a 25 pack-year smoking history, presents with worsening dyspnea and chronic cough. She also takes ramipril 10 mg daily for hypertension. Which of the following is the MOST important step to differentiate a drug-related cough from a COPD-related cough?

Incorrect · Answer: C

PEBC Yield: HighADR-recognitiondrug-interaction

Sputum culture identifies bacterial pathogens in acute exacerbations, not chronic dry cough. ACE inhibitor cough is characteristically dry and nonproductive, making sputum analysis unhelpful for this differentiation.

Alpha-1 antitrypsin deficiency testing is appropriate when evaluating genetic risk factors for COPD, particularly in younger patients or those without smoking history. It does not help distinguish drug-induced cough from COPD cough.

C) (Correct)

Correct. ACE inhibitors such as ramipril cause a persistent dry cough unrelated to COPD. Reviewing the temporal relationship between cough onset and drug initiation is the most direct way to distinguish drug-induced cough from disease-related symptoms. This is a key drug factor identified in COPD assessment.

A chest radiograph can identify structural lung abnormalities such as hyperinflation, but it does not help differentiate ACE inhibitor-induced cough from COPD cough. Both conditions may coexist with normal or abnormal imaging findings.

Question 10Smoking Cessation

KR is a 38-year-old female using nicotine gum 4 mg as needed for smoking cessation. She reports cravings remain strong throughout the day. On review, she chews each piece quickly for a few minutes, often pairs it with her morning coffee or a glass of orange juice, and uses about 6 pieces per day. Which counselling adjustment is most likely to improve effectiveness?

Incorrect · Answer: B

PEBC Yield: Highcounsellingadr-recognition

Switching to a different NRT formulation does not address the underlying technique and acidity issues with the gum she is already using — fix the technique first.

B) (Correct)

Correct. Acidic beverages (coffee, orange juice, soft drinks) reduce buccal absorption of nicotine; CAMH and product monograph guidance recommends waiting at least 15 minutes after acidic intake before using a piece of NRT gum or lozenge.

Continuous biting bypasses the chew-and-park technique — the correct method is to bite a few times, then park between cheek and gum until taste fades, then bite again, over about 30 minutes.

Strength escalation to 6 mg does not exist for nicotine gum (Canadian formulations are 2 mg and 4 mg); addressing absorption and technique should precede any dose change.

Want the full bank?

These are a sample. The full bank adds full-length cases and timed mock exams.

Sample full case

One patient with several linked questions, the format the real exam uses for case clusters.

RM is a 62-year-old male (82 kg) presenting to the family health team for respiratory assessment. He reports progressive shortness of breath on exertion over the past 18 months, occasional morning cough, and increased difficulty keeping up with coworkers on the loading dock where he has worked for 28 years handling grain and industrial dust with inconsistent mask use. He lives alone, eats an unrestricted diet, and walks about 20 minutes daily. Past medical history: seasonal allergic rhinitis (spring only), mild osteoarthritis of the right knee, dyslipidemia, hypertension. No personal or family history of asthma or alpha-1 antitrypsin deficiency. He has never been hospitalized for a respiratory illness. Social: Smoked 15 cigarettes per day since age 22 (approximately 30 pack-years); continues to smoke. Drinks 2 beers on weekends. Lives in a ground-floor apartment; no wood-burning stove. Medications:

Medication	Dose	Frequency	Indication
Ramipril	5 mg PO	Once daily	Hypertension
Rosuvastatin	20 mg PO	Once daily (evening)	Dyslipidemia
Loratadine	10 mg PO	PRN (spring)	Allergic rhinitis
Acetaminophen	500 mg PO	PRN (max 3 g/day)	Knee pain

Vitals: BP 134/82, HR 78, SpO2 96% on room air. Spirometry ordered: post-bronchodilator FEV1/FVC 0.62, FEV1 64% predicted.

Question 1COPD

Which of the following factors in RM's history most strongly predicts his COPD risk?

Incorrect · Answer: C

PEBC Yield: Highrisk-stratificationcopdsmokingoccupational-exposurehistory-taking

Obesity and sedentary behaviour worsen dyspnea perception and functional capacity but are not established causal risk factors for fixed airflow obstruction; COPD is driven by inhalational insults, not adiposity. Would be appropriate if the question were asking about modifiable contributors to exertional dyspnea or deconditioning rather than COPD risk itself.

Occupational dust and chemical exposure is a recognized COPD risk factor and is contributing here, but in an active smoker with a 30 pack-year history, smoking remains the dominant and strongest predictor by a wide margin rather than the occupational exposure. Would be correct if the patient were a lifelong non-smoker with heavy, prolonged occupational dust or fume exposure driving the disease.

C) (Correct)

Tobacco smoke is the single strongest and most prevalent risk factor for COPD, and quantified pack-year exposure (smoking duration and intensity) is the dominant driver of cumulative airway injury and emphysematous change. Canadian Thoracic Society and GOLD frameworks consistently identify smoking as the #1 modifiable COPD risk factor, with risk rising steeply above ~20 pack-years. RM's 30 pack-year burden, continued current smoking, and post-bronchodilator FEV1/FVC <0.7 all align with smoking-driven COPD. Would be incorrect if the patient were a lifelong non-smoker with early-onset disease and a family history, where alpha-1 antitrypsin deficiency would dominate.

Allergic rhinitis is tempting because airway inflammation and atopy are associated with asthma, but isolated seasonal rhinitis without asthma is not an established COPD risk factor and does not explain fixed post-bronchodilator obstruction. Would be appropriate if the stem were asking about asthma-COPD overlap triggered by long-standing uncontrolled asthma with ongoing smoking.

Question 2COPD

Three months later, RM returns for follow-up. Spirometry confirmed mild-moderate COPD and he was started on ipratropium MDI, 2 puffs four times daily. He reports persistent breathlessness climbing stairs and on his loading shift, with no reduction in symptoms since starting therapy. He has not had any exacerbations. Which of the following is the most appropriate next step by the pharmacist?

Incorrect · Answer: B

PEBC Yield: Highinhaler-techniqueadherence-assessmentcopdsamastep-up-therapy

Discontinuing ipratropium and starting an inhaled corticosteroid is incorrect because ICS monotherapy has no role in COPD and is associated with increased mortality, and RM has no exacerbations or eosinophil-driven indication for an ICS. Would be indicated if RM were a patient with asthma-COPD overlap already on LABA/LAMA with documented eosinophilia and recurrent exacerbations, as part of a combination regimen.

B) (Correct)

Persistent symptoms on an inhaled bronchodilator mandate confirmation of inhaler technique and adherence before therapy escalation because poor technique and non-adherence are the most common reasons a prescribed inhaler fails to deliver benefit. Canadian Thoracic Society and GOLD guidance explicitly require a technique and adherence check at every visit and before any step-up or drug switch. RM has only been on ipratropium 3 months with no exacerbations, so confirming device use comes before escalation to a LAMA or dual therapy. Would be incorrect if technique and adherence had already been verified as correct on multiple recent visits and symptoms still persisted.

Adding a LABA is tempting because dual bronchodilation is appropriate for ongoing symptoms, but escalating before confirming technique and adherence risks layering a second device onto an uncorrected root problem and masking the real issue. Would be appropriate if RM's ipratropium technique and adherence were already documented as correct and symptoms persisted at a follow-up visit.

Switching ipratropium (SAMA) to tiotropium (LAMA) is clinically reasonable for ongoing symptoms in stable COPD, but it has the same problem as adding a LABA: changing the agent without first ruling out a technique or adherence issue will not fix a misused inhaler. Would be appropriate as the next step after inhaler technique and adherence have been confirmed as adequate.

Question 3COPD

Six months later, RM is admitted with an acute COPD exacerbation: increased dyspnea, purulent sputum, and SpO2 88% on room air. The admitting team plans to initiate prednisone 40 mg PO daily for 5 days alongside bronchodilator and antibiotic therapy. The medical resident asks the pharmacist which evidence-based benefit systemic corticosteroids most clearly provide in this setting. Which of the following is the most accurate response?

Incorrect · Answer: D

PEBC Yield: Highaecopdsystemic-corticosteroidsevidence-based-medicinelength-of-stayguideline-threshold

Preventing future exacerbations is incorrect because a short AECOPD steroid course does not alter the underlying disease trajectory or reduce future exacerbation frequency once the course ends. Would be indicated if the patient were being started on optimized maintenance therapy such as triple inhaled therapy, azithromycin prophylaxis, or roflumilast, which are the agents with exacerbation-reduction evidence.

Improving long-term quality of life is tempting because patients often feel better during the steroid course, but the evidence does not support a durable post-exacerbation quality-of-life benefit from a single 5-day course and this is a classic PEBC distractor. Would be appropriate if the question were describing pulmonary rehabilitation, which has clear long-term symptom and quality-of-life benefits across COPD severity.

A clear mortality benefit is tempting because steroids improve physiology, but systemic corticosteroids in AECOPD do not consistently reduce mortality in the evidence base; their proven benefits are length of stay, treatment failure, and FEV1 recovery, not survival. Would be correct if the question were about ICS-containing triple therapy with 320 mcg budesonide in stable Category E COPD, where mortality benefit is established.

D) (Correct)

Systemic corticosteroids in AECOPD suppress airway inflammation and oedema, accelerating bronchodilator response and reducing treatment failure. Canadian Thoracic Society and GOLD guidance support a 30-40 mg prednisone equivalent for 5 days without taper, with the most consistent proven benefits being shorter hospital length of stay, faster FEV1 recovery, and lower treatment failure rates. This matches RM's moderate-to-severe exacerbation with hypoxia where inpatient acceleration of recovery is the primary goal. Would be incorrect if the question asked about chronic stable COPD management, where long-term systemic steroids are not indicated and are harmful.

Question 4COPD

During the same admission, the team notes RM has also developed HFrEF (LVEF 30%, on bisoprolol, sacubitril/valsartan, dapagliflozin, and furosemide) and is living with well-controlled HIV on an integrase-inhibitor-based regimen. Admission labs: K+ 3.4 mmol/L, SCr normal, QTc 460 ms on baseline ECG. This is his fourth AECOPD requiring antibiotics in the past year and sputum is purulent. Which of the following empiric oral antibiotics is most appropriate?

Incorrect · Answer: C

PEBC Yield: Highaecopdantibiotic-selectionrespiratory-fluoroquinoloneqt-prolongationdrug-interaction

Ciprofloxacin is tempting because it is a familiar oral fluoroquinolone, but it has the weakest S. pneumoniae coverage of the fluoroquinolones and is not considered a respiratory fluoroquinolone, so it is reserved for Pseudomonas risk rather than routine AECOPD. Would be appropriate if RM had documented Pseudomonas aeruginosa on prior sputum culture or bronchiectasis.

Moxifloxacin covers the typical AECOPD pathogens well, but it carries the highest QT-prolongation risk among the respiratory fluoroquinolones, which is unsafe here given baseline QTc 460 ms, furosemide-driven hypokalemia, HFrEF, and potential antiretroviral QT interactions. Would be appropriate in a patient without QT risk factors, normal electrolytes, and no QT-prolonging co-medications.

C) (Correct)

Levofloxacin is a respiratory fluoroquinolone with strong S. pneumoniae, H. influenzae, and M. catarrhalis coverage appropriate for frequent-exacerbator AECOPD (>=4/year). Canadian Thoracic Society guidance favours respiratory fluoroquinolones or amoxicillin/clavulanate in this frequent-exacerbator group, and among fluoroquinolones levofloxacin carries a lower QT-prolongation signal than moxifloxacin, which matters here given RM's HFrEF, diuretic-induced hypokalemia (K+ 3.4), baseline QTc 460 ms, and antiretroviral co-therapy. Would be incorrect if RM had documented tendinopathy, myasthenia gravis, or a fluoroquinolone-allergy history, where amoxicillin/clavulanate would be preferred.

Azithromycin treatment-dose would cover atypicals but has a meaningful QT-prolongation signal that compounds with RM's hypokalemia, HFrEF, and antiretroviral regimen, and is generally reserved for chronic prophylactic use in selected former-smoker COPD patients rather than acute empiric therapy in a frequent exacerbator. Would be appropriate as chronic three-times-weekly prophylaxis in a former smoker with recurrent exacerbations, normal QTc, and documented MAC-negative status.

Full-length cases like this, across every PEBC domain, live in the question bank.

Frequently asked questions

Is respiratory high yield on the PEBC exam?: Yes. Asthma, COPD, allergic rhinitis, and smoking cessation are core community-practice topics, so they come up often. The exact mix is randomized from one sitting to the next, but respiratory is consistently worth strong preparation, especially inhaler selection and technique.
What respiratory topics should I focus on for the PEBC?: Focus on asthma step therapy, COPD management and exacerbations, inhaler selection and technique, allergic rhinitis, and smoking cessation. Knowing the step-up and step-down logic and the role of each inhaler class matters more than memorizing every product name.
Which guidelines should I use for respiratory on the PEBC?: The Canadian standard references are the Canadian Thoracic Society (CTS) guidelines for asthma and COPD, and the GINA strategy for asthma. The PEBC expects the Canadian approach to step therapy and inhaler selection, so study from CTS rather than from a US source.
How should I study respiratory for the PEBC?: Learn the asthma and COPD step approaches, the inhaler classes and what each does, and how to counsel on inhaler technique. Then read each vignette for the control level or patient factor that changes the answer.