Recurrent asthma despite corticosteroid therapy in a 35-year-old woman.

A 33-year-old woman with a history of asthma presented with shortness of breath and voice loss. Her asthma began 4 years previously, after an inhalational exposure to irritating fumes. She subsequently experienced frequent wheezing associated with voice loss when exposed to dust or chemical fumes despite preventive therapy with bronchodilators and corticosteroids. The patient denied a family history of lung disease, respiratory problems as a child or young adult, or psychiatric illnesses; however, she had felt “down” since developing her work-related pulmonary condition. Her lung function tests between asthma episodes were always normal. Current medications included theophylline, inhaled albuterol, and prednisone (20 mg/d). She did not smoke and denied use of illicit drugs.