12-17-2007, 08:16 AM
A 45-year-old male is evaluated in the clinic for asthma. His symptoms began 2 years ago and are
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characterized by an episodic cough and wheezing that responded initially to inhaled bronchodilators and
inhaled corticosteroids but now require nearly constant prednisone tapers. He notes that the symptoms
are worst on weekdays but cannot pinpoint specific triggers. His medications are an albuterol MDI, a
fluticasone MDI, and prednisone 10 mg PO daily. The patient has no habits and works as a textile
worker. Physical examination is notable for mild diffuse polyphonic expiratory wheezing but no other
abnormality. Which of the following is the most appropriate next step?
A. Exercise physiology testing
B. Measurement of FEV1 before and after work
C. Methacholine challenge testing
D. Skin testing for allergies
E. Sputum culture for Aspergillus fumigatus
23/1/2007 13:18:43
Page 525 of 634
characterized by an episodic cough and wheezing that responded initially to inhaled bronchodilators and
inhaled corticosteroids but now require nearly constant prednisone tapers. He notes that the symptoms
are worst on weekdays but cannot pinpoint specific triggers. His medications are an albuterol MDI, a
fluticasone MDI, and prednisone 10 mg PO daily. The patient has no habits and works as a textile
worker. Physical examination is notable for mild diffuse polyphonic expiratory wheezing but no other
abnormality. Which of the following is the most appropriate next step?
A. Exercise physiology testing
B. Measurement of FEV1 before and after work
C. Methacholine challenge testing
D. Skin testing for allergies
E. Sputum culture for Aspergillus fumigatus