What to do when the inhaler fails: Revisiting the diagnosis

Paradoxical vocal fold movement is important to consider in the differential for dyspnea on exertion or shortness of breath. It is often confused with asthma and remains undiagnosed because of a paucity of pathognomonic examination and imaging findings. This case serves as a reminder of the specific clinical picture, diagnosis, and treatment of paradoxical vocal fold movement. It also highlights the broader importance of continuity of care and the clinician’s ability to revisit the differential diagnosis if an initial workup is unrevealing or the patient is not responding to treatment.