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Occupational asthma — SCE Respiratory MCQ

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HardAsthmaOccupational asthmaSCE Respiratory

A 42-year-old baker has 18 months of cough, wheeze and chest tightness that improves during holidays. Spirometry shows FEV1 2.1 L (68% predicted), FVC 3.8 L (97% predicted), FEV1/FVC 0.55, with 18% reversibility after salbutamol. FeNO is 58 ppb and skin prick testing is positive to flour allergens. What is the most appropriate investigation?

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

The best answer is “Serial peak expiratory flow measurements at and away from work”. Serial peak expiratory flow measurements at and away from work is the investigation that most directly resolves the remaining diagnostic or staging uncertainty at this point in the pathway. The alternatives address different questions, have lower expected yield, or would be premature before this result. The remaining choices—“High-resolution CT chest with expiratory views, within a respiratory pathway”, “Methacholine challenge while continuing work exposure, after safety review”, “Serum total IgE and Aspergillus-specific IgE, after specialist assessment”, “Single pre-shift and post-shift spirometry, 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: Health and Safety Executive: occupational asthma: https://www.hse.gov.uk/asthma/