Imogen, a 19-year-old female with a background of asthma, is referred to ED by her GP with a two-day history of fever and worsening cough and new respiratory distress.

She has a longstanding history of asthma which has been previously well controlled with regular inhaled corticosteroids and bronchodilators as needed.

Imogen also has longstanding allergic rhinitis with associated dysphonia and throat clearing.

There is no associated sore throat, post-nasal drip or globus. She reports a sense of fullness in the chest after eating, but denies heartburn or dysphagia.