慢性阻塞性肺病是急診常見的疾病。氣喘聲及先前的內科病史在診斷慢性阻塞↑生肺病均是很重要的線索。然而，有時上呼吸道阻塞的臨床徵候會被發作中的慢性阻塞性肺病所掩蓋。在此，我們報告一位81歲有慢性阻塞性肺病病史的男性病人，因為明顯的氣喘聲被送來急診室，最後被診斷為喉癌。這個案例有以下三個重點:並非所有老人的氣喘聲都是由慢性阻塞性肺病或氣喘所引起;詳細的理學檢查(例如頸部聽診)對於診斷上呼吸道阻塞是很關鍵的項目;一張頸部側面的X光片對於上呼吸道病仕的評估能有相當的幫助。

Chronic obstructive pulmonary disease (COPD) is seen frequently in the emergency department(ED). Wheezingbreath sounds and the medicalhistory are important clues to identify the diagnosis. However， upper airway obstruction (UAO) is sometimes masked with concomitant COPD exacerbation. We report an 81-year-old man with a history of COPD who presented to our ED with obvious wheezing who was finally diagnosed with laryngeal cancer. This case demonstrate that not all wheezing in elderly patients is asthma or COPD-related; a detailed physical examination (neck auscultation) is critical in upper airway obstruction， and lateral radiography of the neckωuld be helpful in evaluation of upper airway lesions