Chronic Cough and Wheeze

🗒️ Question

A 65 year old man presents to his GP with a history of worsening breathlessness, chronic productive cough and occasional wheezing. He reports that his symptoms are most pronounced in the mornings and that he experiences frequent winter exacerbations of his cough. He has a 40 pack year smoking history though he stopped smoking five years ago. He denies any recent fevers, chest pain or haemoptysis.

On examination, his respiratory rate is 22 breaths per minute, his pulse rate is 88 bpm and his oxygen saturation is 95% on room air. Auscultation reveals reduced breath sounds bilaterally with end-expiratory wheeze. There is no peripheral oedema or jugular venous distension.

Which investigation is most appropriate to confirm the diagnosis?

(A) Arterial blood gas

(B) Chest X-ray

(C) High resolution computed tomography

(D) Peak expiratory flow

(E) Spirometry