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Drug-induced bronchospasm — SCE Respiratory MCQ

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ModerateOtherDrug-induced bronchospasmSCE Respiratory

A 23-year-old woman presents with wheeze and dyspnoea after starting propranolol for migraine. She has asthma controlled on low-dose ICS/formoterol. Peak flow is 58% of best, respiratory rate 28/min and oxygen saturation 94% on air. What is the most likely underlying cause?

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Correct answer: B — Beta2-receptor blockade causing bronchoconstriction

Non-selective beta-blockers can precipitate bronchoconstriction in asthma through beta2-receptor blockade, particularly when symptoms follow initiation. Allergy to inhaled corticosteroid would not be temporally linked to propranolol. Pulmonary embolism and vocal cord paralysis are less consistent with reduced peak flow and wheeze after beta-blocker exposure.

Reference: BNF; BTS/NICE/SIGN Asthma Guideline NG244