A 46-year-old woman presented with difficulty breathing with exertion for the last few months. She had recently been diagnosed with asthma and was prescribed inhaled bronchodilators without significant improvement. She was using rescue bronchodilators three times a day. She denied fevers, chronic cough, hemoptysis, chest pain, nasal congestion, or postnasal drip. There was no history of nocturnal symptoms, heartburn, weight loss, or loss of appetite. She had previously never had a chest radiograph. Her past medical history was otherwise negative. She was using an albuterol metered-dose inhaler as needed. She did not smoke or use any illicit substances. She was unemployed and had no pets. Family history was unremarkable.