American Board of Internal Medicine (ABIM) Certification Practice Exam

How can exercise-induced bronchospasm and asthma be diagnosed?

1. By history alone

2. With normal spirometry findings

3. Through bronchial challenge testing such as methacholine

4. By conducting a peak flow measurement

The correct answer is: Through bronchial challenge testing such as methacholine

Exercise-induced bronchospasm and asthma can be diagnosed through bronchial challenge testing, such as using methacholine. This method involves administering increasing concentrations of a bronchoconstrictor agent, and it helps to assess the airway hyperresponsiveness that is characteristic of asthma. The challenge tests can elicit bronchospasm in individuals who may have normal spirometry results at baseline, which is crucial because asthma can be intermittent and may not always show abnormal lung function between episodes. In contrast, a diagnosis made solely on history can miss important clinical details, as patients might be unaware of specific triggers or may misinterpret their symptoms. Normal spirometry findings do not rule out asthma, as some patients experience normal lung function between attacks. Peak flow measurement is beneficial in monitoring asthma but is less effective than a controlled challenge test in confirming the diagnosis when the condition is suspected but not presenting acutely. Thus, bronchial challenge testing is essential for accurately diagnosing exercise-induced bronchospasm and asthma in a clinical setting.