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This retrospective study on patients with acute exacerbations of COPD admitted to the emergency service of a research hospital was designed to assess the factors that affect treatment outcome in such patients. The records of 81 patients who were hospitalized in their previous exacerbation in our hospital and who were admitted to the emergency service with yet another exacerbation were reviewed. A total of 91 instances of exacerbations during a six month period were classified into two groups according to the time elapsed between the two episodes. Group I (successful treatment, n=73) included the patients admitted with a new exacerbation after at least 30 days of discharge, and group II (treatment failure, n=18) those admitted within the first 30 days after discharge. Group II subjects had severe COPD, a longer smoking history (p=0.008), more frequent exacerbations (p=0.004) and hospitalizations (p=0.003) in the previous year. Long term pharmacological therapy, use of long term oxygen therapy, vaccination status, choice of antibiotics and use of steroids in the previous exacerbation did not differ between the groups. The results of our study demonstrated that treatment failure is more likely to occur in patients who had severe COPD and a higher frequency of exacerbations in the previous year. Therapeutic maneuvers did not appear to affect treatment outcome.