Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory disease characterised by persistent respiratory symptoms and airflow limitation. COPD has a major impact on public health, mainly because of its increasing prevalence, morbidity and mortality. The natural course of COPD is aggravated by episodes of respiratory symptom worsening termed exacerbations that contribute to disease progression. Acute Exacerbations of COPD (AECOPD) can be triggered by a multitude of different factors, including respiratory tract infections, various exposures, prior exacerbations, non‐adherence to treatment and associated comorbidities. AECOPD are associated with an inexorable decline of lung function and a significantly worse survival outcome. This review will summarise the most important aspects regarding the impact of different factors that contribute to COPD exacerbations.

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Cryptogenic organising pneumonia (COP) is an interstitial lung disease, with an unknown aetiology. Treatment is based on oral corticotherapy, starting with attack doses given for 2–6 weeks, followed by gradual tapering over a period of 3–6 months. Relapses are common, especially in the first year. A 51-year-old patient, former smoker, without exposure to noxious substances, presented to the hospital in January 2020 with fever, dry cough and malaise. On chest radiography, lesions suggestive of bronchopneumonia were revealed and antibiotic treatment was started. The patient did not respond to treatment and chest Computed tomography (CT) was performed, which detected pulmonary condensations, predominantly with a subpleural disposition, predominantly in the lower lobes, as well as pleural effusion and minimal pericarditis. Due to the unfavourable disease evolution despite treatment and according to other investigation results, COP diagnosis was raised and oral corticotherapy was prescribed, with a favourable response. The patient complained of reappearance of the initial symptoms at dose weaning and she was reassessed by CT in June 2020. The Coronavirus Disease 2019 (COVID-19) pandemic raised the suspicion of a severe acute respiratory syndrome coronavirus-2 (SARS-COV2) infection, which was infirmed later. Corticotherapy was resumed, and at a check-up after 10 months, broncho-alveolar lavage was performed, with results within normal limits. The evolution of the patient was favourable. In conclusion, in the case of a pneumonia in which there is a discrepancy between the clinic, biologic and imagistic (possibly with a migratory pattern) and the response to treatment, COP must also be considered. Relapses are relatively common, and may occur both during corticotherapy dose reduction and after the end of treatment.