Adenosine is an endogenous nucleoside that plays a major role in the pathophysiology of airway diseases, such as asthma and chronic obstructive pulmonary disease. It is also an effective drug at terminating supraventricular tachycardia and used for pharmacological stress testing with a relatively safe side effect profile. There is a contraindication for the use of adenosine in patients with asthma and a caution to use in patients with chronic obstructive pulmonary disease. We present a case of a 63-year old female patient who was treated with adenosine and subsequently went into respiratory distress. She was placed on bilevel positive airway pressure and had rapid resolution of symptoms.