A 62-Year-Old Woman With Refractory Wheezing

A 62-year-old Hispanic woman, a resident of Puerto Rico, presented with symptoms of chronic cough and shortness of breath for the past 2 years that were slowly and progressively getting worse. She received a diagnosis of asthma on the basis of her history of symptomatic "wheezing" and had been on treatment with inhaled bronchodilators and corticosteroids with minimal symptomatic improvement. The peculiarity of her symptoms was that her dyspnea was worse when she was reclining in bed and she would often hear a "whistling" noise in her throat during those times. Additionally, she reported difficulty swallowing and would often drink water to aid in swallowing food. There was no prior history of endotracheal intubations or surgeries. She denied any history of joint pain, skin rashes, eye pain, hair loss, mouth ulcers, photosensitivity, diarrhea, blood-mixed stool, or blood in the urine.