Acute exacerbations of chronic obstructive pulmonary disease (ECOPD) represent major inflection points in the natural history of the disease, driving accelerated functional decline, reduced autonomy, and increased cardiovascular and mortality risk. This narrative review synthesizes current evidence on the multidimensional impact of ECOPD on patient outcomes, spanning respiratory physiology, muscle function, exercise capacity, inflammation, cardiovascular vulnerability, survival, and performance status. Across physiological domains, ECOPD induces sustained functional impairments that may take weeks to months to normalize. Muscular and functional consequences are similarly profound: Skeletal and diaphragmatic muscle dysfunction, reduced mobility, and long-lasting decrements in exercise tolerance contribute to prolonged disability and reduced quality of life. Systemic and airway inflammation often persists long after the acute phase, promoting recurrent exacerbations, progressive lung injury, and cardiometabolic complications. Cardiovascular instability is a defining feature of the post-ECOPD period, with markedly elevated short- and medium-term risks of myocardial infarction, stroke, arrhythmias, and acute heart failure. Mortality remains substantial post-ECOPD, and recurrent readmissions reflect ongoing physiological fragility. Autonomy, performance status, and health-related quality of life frequently remain impaired months after discharge, emphasizing the long-term functional burden of ECOPD. ECOPD recovery is therefore a subacute, high-risk phase of multisystem instability that requires integrated respiratory, cardiovascular, functional, and rehabilitative strategies. Future directions should prioritize personalized post-ECOPD care, guided by treatable traits, performance-based assessments, biomarkers, and digital monitoring. The development of ECOPD-specific functional endpoints and patient-centered outcomes represents a critical unmet need to advance research and improve long-term prognosis.

A.F.: Conceptualization, project administration, resources, supervision, validation, visualization, writing–original draft, writing–review and editing. N.C.: Conceptualization, supervision, writing–original draft, writing–review and editing. G.S.: Writing–original draft, writing–review and editing. C.D.C.: Writing–original draft, writing–review and editing. G.M.: Writing–original draft, writing–review and editing. V.P.: Writing–original draft, writing–review and editing. E.C.: Resources, supervision, validation, visualization, writing–original draft, writing–review and editing.

Received: 11 December 2025

Accepted: 02 February 2026

Article published online:
24 February 2026

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