A 38-year-old woman presented with progressive worsening of dyspnea, upper chest tightness, and wheezing (inspiratory and expiratory) over the previous 18 months. These episodes occurred with exercise, lasted 3 to 5 min, and resolved without intervention. The symptoms never occurred at night or awakened her from sleep. She had previously been treated with β-agonists without improvement. She denied gastroesophageal reflux, rhinitis, or sinusitis symptoms. She denied a history of atopy, smoking, and could identify no triggers for her dyspnea other than exercise. A physical examination was unremarkable. Flexible fiberoptic rhinolaryngoscopy revealed a normal nasopharynx, a normal hypopharynx/larynx, and normal vocal cord movement.