12th May 2024

A 32-year-old woman presents to the clinic complaining of recurrent episodes of wheezing, breathlessness, and a tight chest.

A 32-year-old woman presents to the clinic complaining of recurrent episodes of wheezing, breathlessness, and a tight chest. These symptoms are particularly severe at night and early in the morning. She mentions that her symptoms worsen when she is exposed to cold air or during exercise. She also reports a chronic dry cough. She has a history of hay fever and eczema.

Spirometry shows reversible airflow obstruction after the administration of a bronchodilator.

Which pathophysiological process is most likely to be responsible for her symptoms?