A 70-year-old woman presented with a 1-month history of increasing dyspnea and a nonproductive cough. She had a history of bronchial asthma, hypertension, carotid endartectomy, diverticular disease, and osteoarthritis. She had no other systemic symptoms and had not smoked for many years. Medications included aspirin, bendrofluazide, inhaled fluticasone, and albuterol.
On clinical examination, she was afebrile with a pulse rate of 90 beats/min and a BP of 140/100 mm Hg. A small mobile lymph node was palpable in the anterior triangle close to the left sternomastoid insertion. There was mild stridor, and wheezing was heard over the left upper lobe. Spirometry showed an FEV1 of 1.6 L/min and FVC of 2.3 L.