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A 50-year-old white female presents to the emergency room with complaints of increased chest congestion with purulent sputum production for the last 3 days. The patient reports she has had some increased dyspnea and is using her albuterol inhaler which isn’t helping her symptoms. The patient reports a history of tobacco use for last 10 years and a history of COPD which was diagnosed last year. The patient reports that her primary care provider ordered another medication for the COPD but she couldn’t afford it. The patient denies fever. The patient’s vital signs: BP 148/90, pulse 108, respirations 22, O2 sat 92%, and temp 98.1F. Chest x-ray reveals hyperinflation with flattened diaphragm but is without effusions or infiltrates.

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