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A 59-year-old man with long-standing chronic obstructive airways disea se (COPD), became progressively dyspnoeic, and repeatedly blacked-out during forced expiration. Spirometry suggested the possibility of larg e airways obstruction, and failing to respond to aggressive bronchodil ator and steroid therapy, the patient was labelled as being non-compli ant. Finally, he was assessed by an otolaryngologist and a cause for u pper airway obstruction was suspected. Bronchoscopy and computed tomog raphy (CT) scanning demonstrated tracheomalacia and the patient underw ent resection of this segment of abnormal trachea. Tracheomalacia, alt hough rare, results from the substitution of cartilage with fibrous ti ssue, leading to severe airway compromise. This case emphasizes the fa ct that although many conditions are uncommon, the total incidence of rare conditions is surprisingly high, and that care needs to be taken at all times in the management of 'labelled' patients with chronic ill ness, in order not to overlook such life-threatening diagnoses.