Athletic physiological spirometry variant — SCE Respiratory MCQ

Correct answer: E — Recognise possible dysanapsis and confirm test quality, repeat spirometry and assess bronchodilator response before labelling disease

The best answer is “Recognise possible dysanapsis and confirm test quality, repeat spirometry and assess bronchodilator response before labelling disease”. A high FVC with normal absolute FEV1 can produce a low ratio through dysanaptic airway–lung growth, particularly in athletes; a result below the lower limit still merits quality review and physiological confirmation before a disease label or treatment. The remaining choices—“Diagnose COPD and start triple inhaled therapy immediately, after specialist assessment, with clinical reassessment, within a respiratory pathway”, “Diagnose asthma and prescribe maintenance oral corticosteroid, with clinical reassessment, within a respiratory pathway, after safety review”, “Diagnose restrictive lung disease because FVC is above predicted, within a respiratory pathway, after safety review, after specialist assessment”, “Exclude all airway disease permanently because absolute FEV1 is normal, after safety review, after specialist assessment, with clinical reassessment”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: ERS/ATS interpretive strategies for routine lung function tests: https://publications.ersnet.org/content/erj/60/1/2101499