Abstract
HISTORY OF PRESENT ILLNESS A previously healthy, 38-year-old male, security guard presents with a 4-month history of shortness of breath with exercise such as running and swimming. He denied symptoms of orthopnea, paroxysmal nocturnal dyspnea, cough, wheeze, and ankle edema. He was prescribed albuterol by inhalation to be taken before exercise and triamcinolone inhaler by his primary care physician with partial improvement. He was referred to us for further treatment for exerciseinduced asthma. Two weeks before his evaluation, he presented to the emergency department complaining of severe dyspnea on exertion. An electrocardiogram (EKG) and chest x-ray examination were normal. Laboratory studies including a complete blood cell count and thyroid function tests were normal. He had discontinued the triamcinolone inhaler.
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