A 45-year-old woman presents with shortness of breath, cough with thick green sputum, and fevers. She has a history of COPD but her symptoms are worse and interfering with sleep. A chest X-ray shows flattened diaphragm and increased lung diameter. Lung auscultation reveals coarse rales and rhonchi. The case requires understanding how cardiovascular and respiratory systems interact and how patient characteristics can impact disease.