A 42-year-old woman who had a diagnosis of asthma since childhood that was refractory to corticosteroid therapy complained of chest discomfort, progressive dyspnea on exertion, and chronic cough, all gradually worsening in severity over the past several years. Her chest pain was described as a constant band-like pressure encircling the chest wall, and was exacerbated by cold weather, exertion, supine position, and forced expiration. The chest pain occasionally radiated to the throat and left shoulder. Both the chest pain and dyspnea were partially relieved by inhaled β-agonist, nitroglycerin, and/or rest. In addition, she complained of intermittent dysphagia for solids and liquids. Her medications included a short-acting β2-agonist, inhaled corticosteroids, and intermittent oral corticosteroids.