Summary: COPD exacerbation results in an acute worsening of respiratory symptoms that requires additional therapy, sometimes in hospital settings. Treatment of COPD exacerbation aims to minimize the negative impact of the current exacerbation and to prevent subsequent events. Short-acting b2-agonists and anticholinergics are recommended as the initial bronchodilators to treat bronchoconstriction. Further systemic corticosteroids can improve lung function, oxygenation and shorten recovery time. Antibiotics, when indicated, can also shorten recovery time, reduce the risk of early relapse and treatment failure. Non-invasive mechanical ventilation should be the first mode of ventilation used in COPD patients with an acute respiratory failure because it improves survival. Maintenance therapy with long-acting bronchodilators should be initiated before hospital discharge.