young_doc
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1. A 17-year-old previously healthy man is evaluated because of shortness of breath on exertion, particularly during basketball season, when he sometimes needs to sit down during practice to catch his breath. He does not notice any shortness of breath with routine activity. There is no family history of asthma. On physical examination, he is in no respiratory distress. His lungs are clear, with no wheezing during either tidal breathing or forced expiration. His heart is normal. Baseline spirometry is normal.
What is the next diagnostic step?
A. Allergy testing
B. Exercise testing with postexercise spirometry
C. Methacholine challenge testing
D. Overnight Oximetry
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| vradojc1
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B
Exercise asthma?
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| Justice
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B. Exercise testing with postexercise spirometry
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| doc_clotaire
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I am betwen Between B or C , but I have to pick !
I would go for B because Exercise testing with postexercise spirometry is MORE SPECIFIC than Methacholine challenge testing ( this one is usually used to asses asthma , If results are positive, they are indicative of asthma in general, not specifically EIA)
so my best guess is B................
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| new_n_lost
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"never argue with a fool, they'll bring you down to their level and beat you with experience" FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| doyoudig
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C. Methacholine challenge testing
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| webjeee
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C
after exercise, all symptoms are gone.
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| young_doc
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Ans: B
"The most likely diagnosis is exercise-induced asthma, and exercise testing with postexercise spirometry is the most appropriate diagnostic test. Exercise testing for exercise-induced asthma should attempt to mimic the activity that induces the shortness of breath. In addition to establishing the diagnosis of exercise-induced asthma, exercise testing can reveal exercise-induced laryngeal dysfunction that sometimes mimics exercise-induced asthma. All patients with significant disease should also be instructed to use prophylactic treatment 5 to 10 minutes before exercise, usually two puffs of a medium-acting inhaled β2-agonist (albuterol).
A better term for this condition is “exercise-induced bronchospasm,” because not all persons with the condition have asthma. The estimated prevalence of exercise-induced bronchospasm ranges from 7% to more than 20% in the general population. Exercise-induced bronchospasm probably results from changes in airway physiology triggered by the large volume of relatively cool, dry air inhaled during vigorous activity. Bronchodilation is the more common first event during exercise and lasts for 1 to 3 minutes after exercise. In patients with exercise-induced bronchospasm, the initial bronchodilation is followed by bronchoconstriction, which begins within 3 minutes, generally peaks within 10 to 15 minutes, and resolves by 60 minutes. Acute bronchoconstriction was previously followed by late-phase bronchoconstriction in some patients; however, the risk and severity of late-phase bronchoconstriction due to exercise-induced bronchospasm is decreased when compared with allergen-induced asthma.
Although some patients with exercise-induced asthma may also have an allergic component, there is no clear correlation between the development of exercise-induced asthma and allergies. Patients with exercise-induced asthma may have equivocal results on methacholine challenge testing, making it a less helpful test than postexercise spirometry. Overnight oximetry would provide no information regarding the onset of bronchospasm during exercise. "
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