This case focuses on differential diagnosis and treatment of chronic obstructive pulmonary disease (COPD) versus asthma. The symptoms of these two inflammatory conditions may overlap in older patients and both may result in exacerbations. The patient presentation for COPD may be very similar to that in older patients with asthma. As a result, there is high potential for misdiagnosis and inappropriate treatment. Differential diagnosis of COPD requires careful evaluation of spirometry results (pre- and postbronchodilator FEV₁) and close attention to patient history.