A 46-year-old woman presented with a 2-year history of exertional dyspnoea and wheeze accompanied by chest tightness and fatigue. These symptoms had progressively worsened over the preceeding 4 to 6 months. She had no significant cough, hemoptysis, or chest pain, and there was no diurnal variation to her symptoms. The patient was a nonsmoker, had no history of asthma or atopy, had no significant family history, and did not take any regular medication.
On examination, the patient looked well, weighing 60 kg with a measured height of 158 cm (body mass index, 24 kg/m2). She was afebrile, her pulse was 72 beats/min and regular, and her BP was 128/84 mm Hg. Her trachea was central with no evidence of tug, and no cervical lymphadenopathy was detected. She had mild audible inspiratory and expiratory noise, but no definite stridor. The chest examination was suggestive of a mild reduction in expansion of the left hemithorax compared to the right, but was normally resonant to percussion. Her breath sounds were vesicular throughout both lung fields with the exception of somewhat harsh breath sounds in the left mid-zone and axilla. She had no evidence of wheeze or crepitations.