A 38-Year-Old Man Is Being Evaluated for Shortness of Breath

A 38-year-old man is being evaluated for shortness of breath, cough, and chest tightness.  He reports that his breathing "gets noisy" sometimes.  The symptoms appeared 3 months ago, last throughout most of the day, and have gradually become more severe.  The patient started working as a research laboratory technician 2 years ago, spending most of his day maintaining rodent colonies.  He is unsure if his respiratory symptoms are related to his arrival at or departure from the animal facility.  The patient's breathing improved when he attended a weeklong conference in another city.  He reports no fevers, night sweats, weight loss, or unusual fatigue.  Vitals signs are within normal limits.  Pulmonary examination reveals normal lung sounds.  Chest x-ray is normal.  Baseline spirometry demonstrates normal airflow rates.  Which of the following diagnostic tests will be most useful for establishing the diagnosis?

A) Aspergillus skin testing
B) CT scan of the chest
C) Evaluation of vocal cord function
D) Peak expiratory flow measurements at home and work
E) Therapeutic trial of intranasal steroid

Correct Answer:

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