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Asthma — SCE Respiratory MCQ

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EasyAsthmaAsthmaSCE Respiratory

A 29-year-old non-smoker has 8 months of episodic wheeze and nocturnal cough, worse after viral infections. Examination is normal between episodes. Blood eosinophils are 0.52 x 10^9/L, FeNO is 62 ppb and spirometry shows FEV1 3.1 L (82% predicted), FVC 4.2 L (92% predicted), FEV1/FVC 0.74 with 420 mL and 14% reversibility after salbutamol. What is the most likely diagnosis?

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Correct answer: A — Asthma

The variable symptoms, raised type 2 inflammatory markers and significant bronchodilator reversibility make asthma the best diagnosis. Inducible laryngeal obstruction can mimic wheeze but would not explain eosinophilia, high FeNO and reversible airflow obstruction. Non-asthmatic eosinophilic bronchitis causes cough with eosinophilic inflammation but spirometry is typically normal without bronchodilator reversibility.

Reference: BTS/NICE/SIGN Asthma Guideline 2024; NICE NG245