Chronic obstructive pulmonary disease (COPD) is seen frequently in the emergency department (ED). Wheezing breath sounds and the medical history 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 demonstrates 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 neck could be helpful in evaluation of upper airway lesions.