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Occupational asthma — SCE Respiratory MCQ

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HardAsthmaOccupational asthmaSCE Respiratory

A 42-year-old bakery worker has episodic wheeze and chest tightness that improve during holidays. Spirometry is normal between attacks, FeNO is 58 ppb and skin-prick testing shows atopy. Peak expiratory flow readings taken twice daily for 4 weeks show marked diurnal variability and a fall on working days. What is the most appropriate investigation to confirm the occupational association?

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Correct answer: A — Serial peak expiratory flow plotted against work and rest days

Serial PEF at and away from work is the usual first-line objective test for suspected occupational asthma when symptoms vary with exposure. Bronchial challenge may support asthma but does not establish a work relationship if done away from exposure. IgE testing and CT are useful in selected differential diagnoses but would not confirm occupational causation.

Reference: BTS/NICE/SIGN Asthma Guideline 2024; BOHRF Occupational Asthma Guideline