A 65 year old male, nonsmoker was admitted into the Pneumology Department with the complaints of productive cough, dyspnea, chest pain and fatigue. He is a known patient, under treatment for chronic obstructive pulmonary disease. Over the years he had multiple lower respiratory tract infections. Physical examination showed bilateral inspiratory crackles and turgid jugular veins. Purulent sputum was analyzed and Pseudomonas aeruginosa was isolated. Blood analysis came normal. Spirometry test showed forced expiratory volume in the first second 35%, forced vital capacity 44% and tiffeneau index of 79. Arterial blood gases showed hypoxemia and hypercapnia with respiratory acidosis. The patient received nasal oxygen at 1.5 liters/minute, bronchodilators, antibiotics associated with mucolytic treatment and physical rehabilitation therapy1. Pneumococcal + flu vaccination, regular follow-up visits were suggested. After 14 days, the patient was discharged and has been doing well since.