CASE PRESENTATION: The patient is a 51 year old woman with a history of asthma, sleep apnea, GERD and obesity who presented for further evaluation of progressively worsening asthma. It was first diagnosed 10 years ago. She complained of wheezing, chest tightness, and severe dyspnea with minimal exertion minimally relieved by bronchodilators and inhaled corticosteroids. She reported that her symptoms were triggered by dust and cold air. On examination, she had diminished breath sounds, most notable on the right. Her symptoms first appeared after her C-section and spirometry at that time showed an FVC of 53%, FEV1 of 53% and FEV1/FVC of 116%. Computed tomography of the chest revealed an elevation of the right diaphragmatic cupola to the T4-T5 level, with the liver entering into the chest cavity and marked volume loss. The patient was referred for diaphragm plication and had surgical correction of the diaphragm to its expected position. There was full expansion of the affected lung leading to near complete resolution of her symptoms.