© 2014 Primary Care Respiratory Society UK/Macmillan Publishers Limited. Background:Effective self-management in chronic obstructive pulmonary disease (COPD) is crucial to reduce hospital admissions and improve outcomes for patients. This includes early detection and treatment of exacerbations by patients themselves.Aims:To explore patient's current understanding and experience of managing and identifying COPD exacerbations at home.Methods:A qualitative, interview-based study was carried out in patient's homes. Interviews were audio-recorded, transcribed and analysed using a grounded theory approach. Forty-four patients (17 women, 27 men; age range 55-85 years), with moderate-to-very-severe COPD, were recruited to the interview study from primary and secondary care settings in Oxford, UK, during 2012-2013.Results:Patients identified exacerbations on the basis of measurable, 'visible' symptoms, such as cough and sputum and 'invisible' symptoms, such as chest sensations and bodily knowledge. Most patients seemed to use a combination of these approaches when identifying exacerbations, according to the symptoms that had the most impact on their well-being. Patients used additional self-management strategies during an exacerbation, such as self-medication (antibiotics and steroids) and monitored their recovery. Contact with health-care professionals usually occurred when patients felt no longer able to manage themselves.Conclusions:Patients use both assessment of objective biomarkers, which are aligned with medical knowledge, and subjective symptoms based on their experience, to identify and manage exacerbations of COPD. Health-care professionals and clinicians should acknowledge this 'expert patient' knowledge and integrate this into patient's care plans to facilitate early recognition and treatment of exacerbations.