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Occupational asthma — ABIM Board MCQ

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HardGeneral Internal MedicineOccupational asthmaABIM Board

A spray painter develops episodic wheeze that improves during vacations. Baseline spirometry is normal and methacholine testing confirms airway hyperresponsiveness. Which test best establishes a relationship to work?

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Correct answer: C — Record serial peak flow at work and away from work

The best answer is “Record serial peak flow at work and away from work”. Work-relatedness is strengthened by repeated objective changes linked to exposure. Serial peak-flow measurements across multiple workdays and days away can demonstrate a reproducible pattern despite normal interval spirometry. A single measurement, nonspecific total IgE or structural imaging cannot establish temporal causation; specific inhalation challenge is reserved for specialized settings.

Reference: CDC/NIOSH Diagnosing Work-related Asthma: https://www.cdc.gov/niosh/asthma/hcp/diagnosing/index.html