Evolution of pulmonary hypertension over 20 years of observation in a patient with COPD is presented. Originally patient presented with normal pulmonary arterial pressure. First bout of pulmonary hypertension was observed during severe pulmonary infection resulting in respiratory failure. Smoking cessation, regular use of bronchodilators and antibiotics during bacterial exacerbations produced long-term stabilisation of FEV1, blood gases and pulmonary arterial pressure.