A 68-year-old man with a 20-year history of wheezing presented with a recent increase in dyspnea, productive cough, and inability to clear secretions. He denied fevers, rigors, chest pain, palpitations, lightheadedness, syncope, headaches, nasal symptoms, or gastroesophageal reflux. During the last 15 years, he received treatment with albuterol and ipratropium inhalers in addition to daily nebulizers, prednisone, salmeterol, montelukast, and fluticasone for presumed asthma. His symptoms had worsened despite being compliant with medication. In fact, during the 5 years prior to our evaluation, he had been hospitalized 12 times for asthma exacerbations, bronchitis, and recurrent respiratory infections. The patient was a nonsmoker, had no secondhand smoke exposure, and had no occupational exposures to toxic substances. Family history was not significant. The patient had no known drug allergies. At the age of 5 years, however, he had aspirated a foreign body that was incompletely removed, resulting in recurrent respiratory infections and a left pneumonectomy at age 23.