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Suspected asthma with normal spirometry — SCE Respiratory MCQ

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ModerateAsthmaSuspected asthma with normal spirometrySCE Respiratory

A 40-year-old man has cough and intermittent wheeze. Spirometry is normal and bronchodilator reversibility is absent. FeNO is 67 ppb and blood eosinophils are 0.34 x 10^9/L; peak flow variability over 2 weeks is 8%. He uses no inhaled corticosteroid. What is the most appropriate investigation?

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Correct answer: B — Bronchial challenge testing

High FeNO supports type 2 airway inflammation, but normal spirometry and low PEF variability leave diagnostic uncertainty, making bronchial challenge an appropriate next objective test. LABA monotherapy is unsafe when asthma is possible, and normal spirometry does not exclude asthma. CT and sputum cytology are not the next standard step for confirming variable airway hyperresponsiveness.

Reference: BTS/NICE/SIGN Asthma Guideline NG245