Exacerbation of chronic obstructive pulmonary disease is a common cause of respiratory failure and ICU admission. A multidisciplinary approach is required to address underlying triggers, optimize a patient’s pulmonary physiology, and provide adequate oxygenation and ventilation. Pharmacists can play a key role in treating coexisting infections, improving respiratory mechanics by reducing airway inflammation and promoting bronchodilation, and using pharmacologic strategies to facilitate supplemental respiratory support when needed.