Which statement best supports the diagnosis of asthma in a school-aged child?

• A. Chronic productive cough with daily symptoms.
• B. Persistent non-reversible obstruction on spirometry.
• C. Episodic wheeze with reversible obstruction on spirometry.
• D. Wheezing only with exercise and never at rest.

Answer: (C)

Asthma shows variable, reversible airway obstruction. When a school-aged child has episodic wheeze that comes and goes, and spirometry demonstrates obstruction that significantly improves after a bronchodilator (typically an increase in FEV1 of at least 12% and 200 mL), this pattern most strongly supports asthma because the airways are hyperresponsive but not permanently fixed. The other patterns don’t fit as well: a chronic productive cough with daily symptoms points more toward a chronic infection or other non-asthma airway disease; non-reversible obstruction suggests fixed airway remodeling or a different problem; wheezing only with exercise can occur in exercise-induced bronchoconstriction, but reversibility on spirometry makes asthma much more likely.