Symptoms vary in their severity from patient to patient and can also vary from day to day in the same patient. They include:

	Breathlessness
	Cough
	Sputum production

Exacerbations
Exacerbations of COPD are episodes when the symptoms (breathlessness, cough and sputum production) deteriorate beyond the normal daily variability. This usually requires a temporary new therapy or combination of new therapies include an increase in the usual inhaled treatments, a course of antibiotics, or steroids to help the new symptoms resolve. These episodes can be frequent. They generally affect the general health, making patients feel less well even when the episode is over. There is also a risk that exacerbations will cause the lung disease itself to progress.
Deciding which extra treatment(s) to give (antibiotics, steroids or both) can often be difficult, but antibiotics are only helpful if a bacterial infection is present. The simplest way to identify a bacterial infection is by looking at the colour of the sputum:

Important Points
1. Exacerbations of COPD are deteriorations in the usual symptoms beyond the normal daily fluctuations
2. Prompt treatment speeds the recovery of the episodes
3. Multiple exacerbations affect general wellbeing and are likely to make the COPD progress
4. Antibiotic therapy is indicated if the appearance of the sputum has changed in specific ways from usual
5. With appropriate antibiotics sputum purulence will usually resolve in 5-7 days
6. Failure of sputum purulence to resolve will require reassessment of treatment