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Occupational asthma — SCE Respiratory MCQ

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HardAsthmaOccupational asthmaSCE Respiratory

A 36-year-old spray painter reports cough, wheeze and chest tightness that improve during holidays. Baseline spirometry in clinic is normal, FeNO is 34 ppb, and a methacholine challenge is positive. He has started wearing a simple paper mask at work but symptoms persist by the end of each shift. His employer asks whether the diagnosis can be confirmed objectively. What is the most appropriate investigation?

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Correct answer: C — Serial peak expiratory flow measurements at and away from work

The temporal relationship with work suggests occupational asthma, and serial peak expiratory flow readings across working and rest periods are the key practical confirmatory test. A single spirometry trace may be normal and does not establish work-related variation. Early objective confirmation matters because prognosis is better when exposure is reduced promptly.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/