An 83-year-old woman with no known systemic disease presented to the emergency department with shortness of breath and audible abnormal breath sounds which she had had for 1 week. She reported that the abnormal breath sounds had been heard intermittently for more than a decade, occurring mostly during forceful expiration, coughing or when she had a common cold. One hour later, respiratory distress with accessory muscle use and paradoxical abdominal movement developed, and she was admitted to the intensive care unit for management of impending respiratory failure. The presumed diagnosis was severe asthma due to bilateral expiratory wheezes …