A 50-year-old morbidly obese female patient with previously diagnosed diabetes mellitus, hypertension, hypothyroidism, and bronchial asthma was admitted to the ICU with a history of sudden worsening breathlessness, cough with expectoration, wheezing, and palpitation. On examination, she was visibly breathless and mildly drowsy with tachycardia and tachypnea. Her oxygen saturation by pulse oximetry was 80%, and her blood pressure was 180/100 mmHg in the right arm in the supine position. Her arterial blood gases were suggestive of acute or chronic respiratory acidosis with marked hypoxemia. On examination of the respiratory system, there was bilateral wheeze and basal end-inspiratory crackles. She was diagnosed with a case of acute asthma and obesity hypoventilation syndrome with hypercapnic respiratory failure. She was treated in the ICU with steroids, bronchodilators, oxygen, and non-invasive ventilation.