Chronic obstructive pulmonary disease is a common and progressive disease characterized by permanent decrease of airflow through the airways, and most often occurs as a result of long-term exposure to harmful particles of tobacco smoke. It is one of the leading causes of morbidity and mortality in the world and represents a significant economic and social burden. The chronic and progressive course of the disease is occasionally punctuated by periods of COPD exacerbations that indicate a worsening of respiratory symptoms beyond normal daily variations which require a change in therapy. Worsening of respiratory symptoms refers to the progression of dyspnea and cough and to the increase in volume and purulence of sputum. Acute exacerbations have a negative effect on the course of the disease; therefore, their recognition and adequate treatment are essential to slow down the progression and ensure the patients quality of life. Due to their heterogeneity in the clinical picture, causes and response to therapy, they are classified into different phenotypes that enable a personalized treatment strategy and better long-term patient outcomes. The most common classification of phenotypes is according to their etiology, which includes infectious causes, environmental factors and internal mechanisms. Bacterial and viral infections are responsible for more than half of the causes of exacerbations, and their recognition is important for the selection of adequate antimicrobial therapy and the implementation of preventive measures such as immunization. Inflammatory cell-based phenotypes can predict the effect of corticosteroid therapy in the treatment of acute exacerbations. Patients suffering from COPD often have other chronic diseases that significantly increase the overall risk for the development of an exacerbation, and then affect the course and treatment of exacerbations. Phenotyping by comorbidities raises awareness of their effect on exacerbations and encourages an interdisciplinary approach to managing exacerbations. The frequent exacerbator phenotype identifies patients who require more frequent controls, modified therapy and greater commitment to preventive measures to reduce the number of exacerbations. Prevention of exacerbations is a crucial part of COPD treatment and is based on regular intake of prescribed therapy and implementation of non-pharmacological treatment measures such as smoking cessation and pulmonary rehabilitation.