Upper airway obstruction due to a subglottic tumor can be easily misdiagnosed as bronchial asthma. We report on a 50-year-old woman who was ultimately diagnosed with subglottic tumor, but who presented with near-fatal asthma. According to her medical history she had been treated with high doses of prednisolone and bronchodilators for the past year for difficult asthma. The patient presented to the Emergency Department (ED) in severe respiratory distress. The chest X-ray study revealed bilateral hyperinflation. The flow-volume curve suggested a fixed airway obstruction. After performing a laryngoscopic examination, a subglottic mass was discovered and an urgent tracheotomy was performed. After the operation, all symptoms and respiratory distress disappeared. This case report emphasizes the fact that not all wheezes are attributable to asthma. Upper airway obstructions can lead to asthma-like symptoms in which establishment of the correct diagnosis may be challenging. © 2004 Elsevier Inc.