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In a patient with nodular emphysema, bronchial stenosis and cor pulmonale [[@b1-amjcaserep-17-525]], treating the underlying bronchial stenosis and bronchiectasis may improve the condition. Airflow obstruction secondary to stenosis causes total lung capacity (TLC) to decrease, while air trapping, reduced lung compliance, and elastic recoil pressure of the small airways may reduce the lung compliance [[@b2-amjcaserep-17-525]]. The presence of interstitial emphysema suggests that the mucociliary transport function has been disturbed, and may also be a component in the pathogenesis of emphysema [[@b3-amjcaserep-17-525]]. During the acute phase of emphysema, supplemental oxygen therapy will improve oxygenation to reverse the hypoxemia. Later, inhalation of α-1 adrenergic agonists, such as epinephrine, or β-2 adrenergic agonists, such as isoproterenol, will reverse the air trapping and produce a positive expiratory pressure (PEP), which would be beneficial for patients with severe emphysema and cor pulmonale [[@b3-amjcaserep-17-525]–[@b5-amjcaserep-17-525]]. However, epinephrine has also been found to induce bronchoconstriction in asthmatic patients [[@b6-amjcaserep-17-525]]. In the present patient, the pulmonary function test showed progressive obstruction in both the small and large airways. These findings are consistent with the pathophysiology of

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