A 35-year-old human immunodeficiency virus negative male current smoker was presented for evaluation of episodic breathlessness accompanied with wheeze which he had been suffering for a period of 18 years. These episodes were associated with sneezing, rhinorrhea and nasal itching. At presentation, the patient has been on inhaled corticosteroid and long-acting beta-2 agonist combination therapy for last 8 years and was compliant, but requires additional oral corticosteroid therapy frequently for control of his symptoms.The patient also has to take frequent doses of oral anti-histamines to control the nasal symptoms. General physical examination The examination revealed no pallor, clubbing or cyanosis.
He was tachypneic with a respiratory rate of 26/min. On auscultation, vesicular breath sounds of equal intensity were audible bilaterally along with rhonchi. Serological investigation…
