PEDIATRIC PUZZLER: Recurrent, severe wheezing in a 17-year-old: Seeking a new chord

You have been asked to see a 17-year-old young woman with recurrent life-threatening episodes of asthma. She was admitted to the pediatric intensive care unit two days earlier with profound dyspnea, her seventh ICU admission and tenth hospitalization since her asthma symptoms began when she was 9 years old.