Patient description: The patient is a 60-year-old Spanish man presenting with shortness of breath about a day before. The symptoms began acutely and progressively worsened. He is a known case of COPD since 2 years ago. The spirometry revealed post-bronchodilator FEV1/FVC = 60% of predicted values. He smokes 20 cigarette per day. His past medical history is remarkable for BPH and he is using Flomax for that. His family history is positive for HTN in his brother. His medication includes Duo-Neb inhaled q4 hr PRN, Vit D3 1000 units per day and Flomax for his PBH. He is an obese man who is acutely ill but oriented and conscious. The vital signs are as bellow: BP: 135/80 RR: 25/min HR: 75 bpm BMI: 40 O2sat: 90%

Clinical trial eligibility criteria: eligible ages (years): 40.0-999.0,  Pulmonary Disease, Chronic Obstructive Subjects must be able and willing to comply with the requirements of the protocol Subject must be aged greater than or equal to 40 years at the time of signing the informed consent form (ICF) Subjects must have a record of a clinical diagnosis of COPD, ACOS or CB Subjects must have moderate to severe airflow limitation based on spirometry:FEV1 percent predicted normal greater than or equal to 40 to less than or equal to 80% and post-bronchodilator FEV1/forced vital capacity (FVC) ratio less than 0.7 Subjects must be symptomatic, defined as having a CAT score greater than or equal to 10 Subjects must have a documented history of at least 1 LRTI treated with antibiotics and/or oral/systemic corticosteroids, which may an exacerbation of COPD, in the 12 months prior to Screening, and must have not experienced either of these in the 4 weeks prior to Screening, and must be determined to be stable-COPD by the investigator Subjects must be current or former tobacco (cigarette) smokers with a smoking history of greater than or equal to 10 pack-years Subjects may be male or female For female subjects: A female subject is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions applies: Is not a woman of child bearing potential (WOCBP) or Is a WOCBP and using an acceptable contraceptive method during the study period.The investigator should evaluate the effectiveness of the contraceptive method. A WOCBP must have had a highly sensitive urine pregnancy test within 2 weeks prior to enrolment that proved negative. If a urine pregnancy test cannot be confirmed as negative (example given [e.g.], an ambiguous result), a serum pregnancy test is required. In such cases, the subject must be excluded from participation if the serum pregnancy result is positive. The investigator is responsible for review of subject's medical history, menstrual history, and recent sexual activity to decrease the risk of including a woman with an early undetected pregnancy Subjects must be capable of giving signed informed consent  Subjects with a diagnosed respiratory disorder other than COPD, ACOS or CB (such as: sarcoidosis; active tuberculosis or are receiving tuberculosis treatment; clinically significant bronchiectasis (greater than 20% lung damage on computed tomography [CT] scan), lung fibrosis, pulmonary embolism, or pneumothorax; lung cancer diagnosed within the previous 5 years; asthma only or a current primary diagnosis of asthma in the opinion of the investigator); or chest imaging revealing evidence of clinically significant abnormalities not believed to be due to the presence of COPD Subjects with a diagnosis of alpha-1 antitrypsin deficiency as the underlying cause of COPD Subjects who have had lung surgery within 12 months prior to Screening, or plans to have lung surgery within 12 months after study entry Subjects with any confirmed or suspected immunosuppressive or immunodeficient condition, based on medical history and physical examination (no laboratory testing required) Subjects who have a psychiatric disorder or any other condition that interferes with the ability to understand the study procedures Subjects who have received antibiotics within 1 month of Screening or have received antibiotics for more than 30 days within 90 days prior to Screening Subjects who have received systemic corticosteroids (oral/intravenous/intramuscular) for more than 14 consecutive days within 90 days prior to giving informed consent Subjects who have received macrolides for more than 30 days within 90 days prior to Screening Subjects who have received chemotherapy for cancer in the 12 months prior to Screening Participation in the study would result in loss of blood or blood products in excess of 500 milliliter (mL) within 12 months