ABSTRACT
CASE PRESENTATION: A 31-year-old woman (gravida 3 and para 1-0-1-1 at 20 weeks gestation) was admitted to the hospital for a presumed acute asthma exacerbation. She had a history of severe persistent asthma since childhood. She described her symptoms as progressively worsening since the beginning of her pregnancy. In addition to her dyspnea and wheeze, both of which occurred at rest and with exertion, she complained of worsening hoarseness and mild dysphagia of solid foods over the week before admission. Her primary care provider treated her with a combined corticosteroid and long-acting beta-agonist inhaler, albuterol inhaler and nebulizer, azithromycin, and two courses of prednisone without improvement. Her allergist performed a handheld spirometry 2 months before admission that was repeated 3 weeks later in the office. She had a social history of alcohol dependence but had been sober for 9 months. She was a former one-pack-per-day smoker but quit 20 weeks before admission and used marijuana occasionally. She had no known occupational or inhalation exposures.