A renewed interest in the clinical and pathogenic aspects of COPD exacerbat
ion is timely in view of national and global COPD initiatives. The three bi
g problems regarding COPD continue to be the following: prevention of the d
isease; slowing progression of the disease once diagnosis has been establis
hed; and prevention and more effective treatment of the so-called exacerbat
ion. The following assessment will raise more questions than answers and wi
ll review some of the past and current concepts and contexts.