A 71 year old man, who had smoked 40 cigarettes per day throughout his adult life, had a history of "chest trouble" for 40-50 years. Three days before his death, he developed increasing cough with yellow phlegm (sputum) and shortness of breath. At autopsy, the bronchi showed advanced changes of chronic bronchitis. There was left lower lobe pneumonia, while the right lung had obvious destruction of air sac walls (emphysema), the middle lobe being transformed into an air cyst. The heart showed right ventricular wall enlargement (8 mm thick, normal is up to 5 mm).