12-14-2016, 07:02 AM
A previously healthy 35-year-old man is evaluated for episodic wheezing, dyspnea, and cough. Two months ago he had an acute episode of cough, dyspnea, wheezing, and chest tightness within minutes of inhaling high concentrations of chlorine gas after an accidental spill at work. At that time he was examined in the emergency department; chest radiograph was reported to be normal and he received a brief course of antibiotic therapy and oral corticosteroids. The patient has no prior history of asthma or allergies and is healthy otherwise. The physical examination is normal. Spirometry shows a forced expiratory volume in 1 second (FEV1) of 90% of predicted; FEV1/FVC is 82%.
Which of the following is the most appropriate next test in this patient's evaluation?
A Bronchoscopy with endobronchial biopsy
B Methacholine challenge test
C Inhalation challenge with increasing concentrations of chlorine
D Spirometry before and after work shift
Which of the following is the most appropriate next test in this patient's evaluation?
A Bronchoscopy with endobronchial biopsy
B Methacholine challenge test
C Inhalation challenge with increasing concentrations of chlorine
D Spirometry before and after work shift