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" Have you got asthma?"

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Her pulmonary function test revealed a mild obstruction (FEV1 = 78%, FVC = 76%, FEV1/FVC = 89%) with a reversibility of forced expiratory volume in 1 second FEV1 > 12%. Lung functions were assessed with a spirometer (Sensormedics, S3513, California, USA). Nasal smear cytology revealed normal epithelial cells, skin prick testing was performed with 20 common aeroallergen and positive (histamine) and negative (saline) controls (Stallergenes, France) demonstrating sensitization to house dust mites (Dermatophagoides pteronyssinus:  4x4mm, D.Farrinae:  4x4mm). Her complete blood count values were as follows; haemoglobin: 12.7 mg/dl, leukocyte: 7600 x 103 /ul, thrombocyte count: 323 x 103 /ul, mean corpuscular volume (MCV): 79 fl, absolute neutrophil count: 4900/mm3, absolute monocytes count: 500/mm3 , absolute lymphocyte count: 2000/mm3,  and absolute eosinophil count: 200/mm3. Blood biochemistry, urinary analysis, C-reactive protein and erythrocyte sedimentation rate results were normal. Her chest X-ray was normal. As she had a family history of rheumatic diseases, ANA, Anti-DNA ds, RF were determined and revealed negative results.

The patient was diagnosed as mild persistent asthma and was prescribed intranasal and inhaled corticosteroid therapy (Budesonide 800µg/day), whereby on follow up period of two years, she had two to three asthmatic exacerbations per year despite effective environmental control, good compliance of medication and appropriate usage of inhaler corticosteroid. Her recurrent upper respiratory tract infection, mostly sinusitis, persisted. Other than respiratory and sinusitis infections, she had no other complains with a regular menstruation cycle since she was 12 years old.

* At this point what is your next step for gaining control of the disease and which additional diagnostic studies might be helpful for diagnosis? *