Asthma · AME

Question · easy

A 28-year-old woman has 6 months of episodic cough and wheeze, worse at night and with viral colds. Office spirometry shows FEV₁ 2.31 L (68% of predicted). Which post-bronchodilator result confirms reversible airflow obstruction and supports the diagnosis of asthma?

FEV₁ 2.45 L (increase of 6% and 140 mL) FEV₁ 2.50 L (increase of 8% and 190 mL) FEV₁ 2.62 L (increase of 13% and 310 mL) FEV₁ 2.49 L (increase of 12% and 180 mL)

Question · medium

A 24-year-old competitive swimmer without known asthma develops chest tightness and cough during hard training sessions; symptoms resolve with rest. Exercise challenge shows a 15% fall in FEV₁. In addition to warm-up and warming inhaled air, the most appropriate initial pharmacotherapy is:

Daily oral montelukast as sole therapy As-needed low-dose inhaled glucocorticoid–formoterol before or with exercise Scheduled salmeterol twice daily Scheduled inhaled ipratropium before exercise

Question · medium

A 45-year-old man takes daily low-dose inhaled corticosteroid with as-needed SABA. Adherence, inhaler technique, and comorbidities have been verified and addressed, yet he has daytime symptoms 4 days per week and nocturnal awakening twice monthly; FEV₁ is 84% of predicted. The most appropriate next step is:

Step up to combination ICS–LABA therapy (e.g., low-dose ICS–formoterol maintenance and reliever therapy) Refer for bronchial thermoplasty Switch to as-needed SABA alone Add maintenance oral prednisone 10 mg daily

Question · hard

A 52-year-old woman has had three exacerbations requiring oral glucocorticoids in the past year despite high-dose ICS–LABA. Adherence, technique, and comorbidities are optimized. Blood eosinophils are 380/µL, total IgE is normal with negative perennial-allergen testing, and FeNO is 18 ppb. The most appropriate add-on therapy is:

Anti-IL-5 therapy (e.g., mepolizumab or benralizumab) Omalizumab Scheduled nebulized ipratropium Maintenance prednisone 20 mg daily without a biologic trial

Question · medium

A 38-year-old warehouse worker reports cough and wheeze that worsen during work shifts and improve on weekends and vacations. Office spirometry between exposures is normal. The most appropriate way to confirm the suspected diagnosis is:

Methacholine challenge after two weeks away from work Measurement of total serum IgE Spirometry before and after workplace exposure (or serial peak-flow monitoring) High-resolution CT of the chest