Patient description: A 39-year-old man came to the clinic with cough and shortness of breath that was not relieved by his inhaler. He had these symptoms for 5 days during the past 2 weeks. He doubled his oral corticosteroids in the past week. He is a chef with a history of asthma for 3 years, suffering from frequent cough, wheezing, and shortness of breath and chest tightness. The symptoms become more bothersome within 1-2 hours of starting work every day and worsen throughout the work week. His symptoms improve within 1-2 hours outside the workplace. Spirometry was performed revealing a forced expiratory volume in the first second (FEV1) of 63% of the predicted. His past medical history is significant for seasonal allergic rhinitis in the summer. He doesn't smoke or use illicit drugs. His family history is significant for asthma in his father and sister. He currently uses inhaled corticosteroid (ICS) and fluticasone 500 mcg/salmeterol 50 mcg, one puff twice daily.

Clinical trial eligibility criteria: eligible ages (years): 45.0-999.0,  Chest Pain Coronary Artery Disease Angina All patients who meet and enroll in the parent study will be eligible to participate in 1. New or worsening chest pain syndrome or equivalent symptoms suspicious for clinically significant coronary artery disease 2. No prior evaluation for this episode of symptoms 3. Planned non-invasive testing for evaluation of possible coronary artery disease 4. Men age > 55 and women age ≥65 years 5. If age in men 45 or women 50 years, then must have increased probability of CAD due to A. Diabetes Mellitus (DM) requiring medical treatment OR Peripheral Arterial Disease (PAD) defined as documented >50% peripheral arterial stenosis treated medically or invasively OR Cerebrovascular disease (stroke, documented > 50% carotid stenosis treated medically or invasively) OR B. At least one of the following cardiovascular risk factors Ongoing tobacco use Hypertension Abnormal ankle-brachial index defined as less than <0.9 Dyslipidemia 6. Serum creatinine < 1.5 mg/dL within the past 90 days 7. Negative urine/serum pregnancy test for female subjects of child-bearing potential and not breast-feeding  Diagnosed or suspected acute coronary syndrome requiring hospitalization or urgent or emergent testing; Elevated troponin or creatinine kinase-MB 2. Hemodynamically or clinically unstable condition (systolic blood pressure < 90 mmHg, atrial or ventricular arrhythmias, or persistent resting chest pain felt to be ischemic despite adequate therapy) 3. Known coronary artery disease with prior myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting or any angiographic evidence of coronary artery disease ≥50% lesion in a major epicardial vessel. 4. Any invasive coronary angiography or non-invasive anatomic or functional cardiovascular test for detection of coronary artery disease, including coronary computed tomographic angiography and exercise electrocardiogram, within the previous twelve (12) months. 5. Known significant congenital, valvular (> moderate) or cardiomyopathic process (hypertrophic cardiomyopathy or reduced systolic left ventricular function (left ventricular ejection fraction ≤ 40%)) which could explain cardiac symptoms. 6. Contraindication to undergoing a coronary computed tomographic angiography, including but not limited to: a. Pregnancy or breastfeeding 7. Life expectancy < 2 years 8. Unable to provide written informed consent or participate in long-term follow-up