Snapshot A 68-year-old man with a history of hypertension, heart failure, and emphysema presents to the emergency department with worsening shortness of breath and purulent sputum production. His symptoms began approximately 4 days ago, where he has had difficulty cleaning around the house and walking 1 block. Prior to this event, he was able to walk 7-10 blocks without much difficulty and did not experience dyspnea at rest. He has a 45-pack-year smoking history. He has not received the influenza vaccine. He has been hospitalized 5 times within the past year for similar symptoms. He is febrile and his oxygen saturation is 85% on room air. On physical exam, the patient appears uncomfortable and is having trouble completing his sentences. Chest radiography demonstrates hyperinflated lungs. A sputum culture is obtained and an arterial blood gas is significant for hypercarbia, hypoxemia, and acidemia. He is started on supplemental oxygen, inhaled ipratropium, albuterol, intravenous methylprednisolone, and levofloxacin. Introduction Definition login to view 5 more bullets Prevention login to view 3 more bullets Epidemiology Risk factors login to view 6 more bullets Etiology Respiratory infections login to view 8 more bullets Congestive heart failure Pulmonary embolism Presentation Symptoms login to view 2 more bullets Physical exam login to view 6 more bullets Imaging Chest radiography login to view 5 more bullets Studies Arterial blood gas login to view 2 more bullets Pulse oximetry Treatment Conservative login to view 5 more bullets Medical login to view 24 more bullets PROGNOSIS Associated with an increased mortality