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I had recently been appointed as senior registrar in respiratory medicine and was keen to impress. She was a young woman who had been rereferred to the chest clinic by her general practitioner. He was unhappy that her symptoms were recurring. The initial impression had been that she may have underlying asthma to explain her troublesome cough. However, investigations on these lines were negative, and even a methacholine challenge test proved inconclusive. Nevertheless, her cough seemed to have improved with lignocaine nebulisation.

She was intelligent …