2 |  |
You institute appropriate therapy. Your patient is well controlled on fluticasone 110 mcg, 2 puffs, twice a day, with minimal use of rescue inhalers. She returns to see you in a year. She is fine during the day but reports that she has increased her beta-2 agonist use and has developed nocturnal wakening secondary to cough and dyspnea. She denies any recent upper respiratory infections or other illnesses. On physical examination, she has gained weight and is in no acute respiratory distress. She is afebrile with no signs of infection. Her lung exam reveals scattered wheezes. Upon further questioning, she relates a significant increase in her caffeine consumption associated with a new job she started 2 months ago. She also notes a brackish taste in her mouth in the morning.
Based upon this history and exam, which of the following is the most likely diagnosis? |