This case presentation describes an elderly male with a history of chronic breathlessness and cough for over 10 years that has recently exacerbated. On examination, he has signs of barrel chest, decreased breath sounds and diffuse rhonchi bilaterally. The provisional diagnosis is an acute exacerbation of chronic obstructive pulmonary disease given his risk factors of smoking and history, though chronic bronchial asthma cannot be ruled out. Further tests like spirometry are needed to confirm the diagnosis.