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Question 15#

A 30-year-old athlete presents to your office complaining of intermittent wheezing. This wheezing begins shortly after running. The patient admits to smoking 1 to 2 packs of cigarettes per day for 5 years. What finding would be consistent with asthma? 

A. Hyperinflation on chest x-ray
B. Improvement in FEV1 after bronchodilator
C. Low oxygen saturation on finger oximetry
D. Decreased FVC on PFT testing
E. Dyspnea on assuming a supine position

Correct Answer is B

Comment:

 Asthma is an inflammatory process with reversible air-flow obstruction. This patient’s presentation suggests exercise-induced asthma. Asthma is an incompletely understood disease that involves the lower airways and results in bronchoconstriction and excess production of mucus. This, in turn, leads to increased airway resistance and occasionally respiratory failure and death. In any obstructive lung disease such as chronic obstructive pulmonary disease, hyperinflation may be present on chest x-ray and FEV1 may be decreased. Only in asthma is the airway obstruction fully reversible. Hypoxia would be unusual in exercise-induced asthma and would suggest an alternative diagnosis. Reduced forced vital capacity (FVC) characterizes restrictive lung disease, not obstructive (airways) disease. Dyspnea on assuming a supine position would suggest congestive heart failure.