A 23 year old woman with an 11 year history of asthma comes to your office because of increased use of her albuterol inhaler during the past 7 weeks. Her asthma was previously well-controlled with inhaled glucocorticoids. She has a 3 year history of generalized anxiety disorder controlled with fluoxetine and a 6 year history of migraines. The migraines have been well\-controlled with sumatriptan until 5 months ago when she began having headaches three times a week; her neurologist added propranolol at that time. She has been on oral contraceptives for the past year. She has been under mounting stress at professional school and her personal life over the last 4 months; during which, she has had five cups of coffee daily (usually one cup daily). She does not abuse alcohol or take illicit drugs. She appears mildly anxious but is not in any respiratory distress. There are faint end-expiratory wheezes heard. The rest of her exam is normal. What is the most likely casue of the exacerbation of this patient's asthma?
(A) Increased caffeine intake
(B) Oral contraceptive therapy
(C) Sumatriptan therapy
(D) Propranolol therapy
(E) Fluoxetine therapy
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