Inhaled bronchodilators and a ventilatory support system were applied, but dyspnea persisted. She was then transferred to our ICU for further management. One day later, persistent CO2 retention and drowsy consciousness were found. She was intubated, but expiratory wheezing was noted occasionally despite the inhalation of high-dose bronchodilators and corticosteroids. She was extubated on the sixth hospital day after passing a spontaneous breathing trial under a pressure support of 5 cm H2O. Unfortunately, dyspnea, tachycardia, and expiratory wheezing were noted soon after extubation, requiring using a ventilatory support system. The arterial blood gas showed a pH of 7.28, Paco2 of 72 mm Hg, Pao2 of 81 mm Hg, and a bicarbonate concentration of 32 mEq/L. She was reintubated immediately. Thoracic CT scan (Fig 2) and bronchoscopic images with a positive end-expiratory pressure (PEEP) of 0 cm H2O at the level of the lower trachea (Fig 3, top left, a, and bottom left, d), right mainstem bronchus (top center, b, and bottom center, e), and left mainstem bronchus (top right, c, and bottom right, f) during inspiration (top row) and expiration (bottom row) are shown.