A 65 year old male was admitted with the chief complaint of increased shortness of breath and a cough productive of yellow sputum for three weeks. The patient states that he has had "bronchitis" and "asthma" for several years resulting in a chronic cough, usually productive of one to two tablespoonfuls of mucoid sputum daily, as well as persistent mild to moderate dyspnea on exertion. Overall, while he describes having “some good days and some bad days”, he always experiences some dyspnea on exertion. He uses a beta-agonist inhaler occasionally, with some mild relief of dyspnea, and is prescribed antibiotics once or twice a year. For the past several days, however, his inhalers have failed to relieve his dyspnea, he has been sleeping poorly, and he complains of having increasing difficulty coughing up his sputum. He denies fever, night sweats, or weight loss. He admits to a 100 pack year smoking history, although he has recently cut down to 1/2 pack per day.