A 43 year-old Chinese woman who

immigrated to the United States in

1994 was seen because of several years

of chronic, intermittent coughing

that was productive of voluminous,

thick, green sputum with occasional

blood streaking. The cough was

accompanied by right anterior

pleuritic chest pain. She had no

fevers, chills, or night sweats. Her

medical history included childhood

pneumonia at the age of 18 months,

a prior right pneumothorax that

required chest tube placement, and a

positive PPD. She was a nonsmoker.

Despite her symptoms, she was fully

functional with activities of daily

living but unable to tolerate exercise.

She worked as a part-time seamstress

and had no environmental exposures.

Review of systems was significant

only for a 20lb weight loss in the past 2 years.