Chronic obstructive pulmonary disease (COPD) and is associated with worsened clinical symptoms and prognosis. The prevalence of PH-COPD is not concretely established as classification criteria vary historically, but the presence of severe disease out of proportion to underlying COPD is relatively rare. Right heart catheterization, the gold standard in diagnosis of PH, is infrequently performed in COPD, and the overlap in the clinical symptoms of PH and COPD presents diagnostic challenges. Proven treatments are limited. Trials exploring the use of vasodilator therapy in this patient group generally demonstrate improvements in hemodynamic accompanied by worsening gas exchange without clearly demonstrated improvements in clinically meaningful outcomes. In-depth workup of underlying pulmonary hypertension and use of pulmonary vasodilator medications may be appropriate on an individual basis. We present a case study and a review and discussion of the pertinent literature on this topic. Chronic obstructive pulmonary disease (COPD) is a very common condition especially found among those of the older generation who have a history of smoking, a widely accepted practice where harmful effects were not known in the 1940’s, 1950’s, and even the early 1960’s (Cummings & Proctor, 2015). The long term effects of smoking were eventually understood in the scientific community as people would present with cases of diminished lung function. The risks were published and shared with the public as the medical community better understood the phenomenon (Cummings & Proctor, 2015). After the effects of smoking on lung function became better understood, treatments were devised and experimented to help improve respiratory status. Reactive airway disease and its treatment also played a role in the development of treatment for those who had the condition labeled as chronic obstructive pulmonary disease (COPD). Some of the treatments that were developed were in the classes of medications labeled as beta 2 agonists, anticholinergics, also known as muscarinic receptor antagonists, and corticosteroids. Each agent demonstrates a specific modality to help improve air exchange in individuals whose lung function has been compromised by bronchoconstriction, the lack of functional alveoli, airway inflammation, and excessive sputum production. Here presents a case of a 70 year old female who has a