A 44-year-old man with a long smoking history, COPD, and hypertension presented to the emergency department with 5 days of fever, productive cough, and shortness of breath. He had a 2-year history of dyspnea after walking one city block. Spirometry performed several months earlier showed a FVC ratio (FEV1/FVC) of 62% of predicted. He worked in a factory with extensive exposure to sawdust. His medications included diltiazem, albuterol, and salmeterol inhalers. He denied any allergies, and his family history was noncontributory.