A 50-year-old man with rheumatoid arthritis, bronchiolitis, and obesity was hospitalized to evaluate the worsening of chronic dyspnea. His chronic dyspnea was thought to be secondary to bronchiolitis and had been stable for 10 years. Two months prior to hospital admission, he began to notice a progressive worsening in exertional dyspnea. At baseline, he became short of breath walking up a flight of stairs; however, over the last 2 months it had progressed to the point where he was short of breath walking < 50 feet on flat ground. He reported a daily nonproductive cough but denied fever, chills, night sweats, or weight loss. He denied any orthopnea, paroxysmal nocturnal dyspnea, or chest pain. He had gained 40 lb during the last 10 years, which he attributed to physical inactivity. His medical history was significant for hypertension. His medications included the following: prednisone, 5 mg tid; sulfasalazine; leflunomide; hydrochlorothiazide; ibuprofen; omeprazole; and inhaled fluticasone/salmeterol.