The primary care pediatric nurse practitioner is examining a school-age child who has had several hospitalizations for bronchitis and wheezing. The parent reports that the child has several coughing episodes associated with chest tightness each week and gets relief with an albuterol metered-dose inhaler. What will the nurse practitioner order?

The primary care pediatric nurse practitioner is examining a school-age child who has had several hospitalizations for bronchitis and wheezing. The parent reports that the child has several coughing episodes associated with chest tightness each week and gets relief with an albuterol metered-dose inhaler. What will the nurse practitioner order?

• A. Allergy testing
• B. Chest radiography
• C. Spirometry testing
• D. Sweat chloride test

Answer: (C)

When a school-age child has recurrent wheezing and chest tightness that improves with a bronchodilator, the best first step is to obtain spirometry. This test gives an objective measure of airway function and can demonstrate reversible airway obstruction, which is characteristic of asthma. By measuring how much air the child can forcefully exhale (and how quickly) before and after using a bronchodilator, you can confirm the presence of asthma, assess its severity, and establish a baseline to monitor control over time. This makes spirometry the most informative and appropriate test in this scenario. Allergy testing can help identify triggers but does not confirm asthma or quantify airway function. Chest radiography isn’t routinely needed to diagnose asthma and is reserved for evaluating other concerns such as infection, complication, or alternative diagnoses. Sweat chloride testing is for cystic fibrosis and not related to typical asthma evaluation. Spirometry is particularly feasible and reliable in school-age children who can perform the maneuvers, making it the diagnostic choice here.

When a school-age child has recurrent wheezing and chest tightness that improves with a bronchodilator, the best first step is to obtain spirometry. This test gives an objective measure of airway function and can demonstrate reversible airway obstruction, which is characteristic of asthma. By measuring how much air the child can forcefully exhale (and how quickly) before and after using a bronchodilator, you can confirm the presence of asthma, assess its severity, and establish a baseline to monitor control over time. This makes spirometry the most informative and appropriate test in this scenario.

Allergy testing can help identify triggers but does not confirm asthma or quantify airway function. Chest radiography isn’t routinely needed to diagnose asthma and is reserved for evaluating other concerns such as infection, complication, or alternative diagnoses. Sweat chloride testing is for cystic fibrosis and not related to typical asthma evaluation. Spirometry is particularly feasible and reliable in school-age children who can perform the maneuvers, making it the diagnostic choice here.