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A 72-year-old woman presented with a 6-month history of productive cough, hoarseness and exertional dyspnoea. She is a never-smoker with a history of treated bowel cancer, basal cell carcinoma and hiatus hernia. Physical examination, chest X-ray and blood tests were unremarkable. Spirometry and transfer factor were normal, but her flow volume loop showed fixed large-airway obstruction.