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Asthma diagnostic uncertainty — SCE Respiratory MCQ

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ModerateAsthmaAsthma diagnostic uncertaintySCE Respiratory

A 41-year-old man has suspected asthma but normal clinic spirometry. FeNO is 18 ppb and blood eosinophils are within the laboratory reference range. Twice-daily peak expiratory flow recordings for 2 weeks show amplitude percentage mean variability of 24%. What is the most appropriate management?

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Correct answer: E — Diagnose asthma and start ICS-containing treatment

Significant peak-flow variability supports asthma when initial inflammatory biomarkers and spirometry are not diagnostic. Normal FeNO does not exclude asthma, particularly if symptoms are variable or testing is performed outside symptomatic periods. CT pulmonary angiography and pleural ultrasound do not address the demonstrated variable airflow limitation.

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