Case 2

A 33-year-old female with a history of asthma and allergic rhinitis presents because of recurrent asthma exacerbations and daily coughing, wheezing and sputum production. She reports three asthma exacerbations in the past 6 months, but with neither fever nor haemoptysis. She has been treated with inhaled corticosteroids (ICS) in combination with a long-acting β-agonist (LABA) and has received different short courses of prednisone with partial improvement in her symptoms. Spirometry demonstrated a FVC of 2.99 L (80% predicted) and FEV1 of 1.58 L (51% pred) with a FEV1/FVC ratio of 0.53. Physical examination revealed normal vital signs. Bilateral wheezing was present. A chest radiograph was performed and is shown in figure 1.