Chronic obstructive pulmonary disease (COPD) exacerbations are responsible for a significant proportion of the excessive clinical burden of this global disease. While the most severe of these events may require care in a hospital, the great majority are managed in primary care. Treatments are available to both prevent exacerbations and to improve recovery—however, many patients fail to recognize these events or seek therapy for them. The reasons why some exacerbations are reported and treated and others are not are complex, involving patient, caregiver, and primary care practitioner. This review considers the potential impact of unreported exacerbations in primary care, potential explanations for this phenomenon, and strategies available to reduce their incidence and impact.