TY - JOUR T1 - A young man with dyspnoea and audible expiration: the loops never lie JF - Breathe JO - Breathe SP - 159 LP - 163 DO - 10.1183/20734735.007015 VL - 12 IS - 2 AU - Hisham Taher AU - Megan Samuelson AU - Brian Gehlbach AU - Thomas Gross Y1 - 2016/06/01 UR - http://breathe.ersjournals.com/content/12/2/159.abstract N2 - A 28-year-old Asian man noted the insidious onset of exertional dyspnoea over a 4-month period. This was associated with an intermittent dry cough and expiratory wheezing noted only with exercise. He noted no specific aggravating or ­alleviating factors and denied associated haemoptysis, chest pains, acid reflux, or systemic findings such as fever, sweats or weight loss. He had no prior history of childhood asthma. He was a full-time student without a recent change in environmental or occupational exposures. He denied choking while eating or drinking, changes in his voice or exposure to ill contacts. Evaluation by his primary care provider included a normal physical examination and a normal chest radiograph (figure 1). Spirometry was interpreted as showing a moderately severe obstructive defect (figure 2; initial presentation). There was no reversibility with bronchodilator (not shown).Spirometry provides clues to solving this puzzle of dyspnoea and wheeze in a young nonsmoker—the loops never lie! http://ow.ly/YC9zIA 10 s recording of expiratory sounds from this case can be found at: http://ow.ly/UVVu300moD1 ER -