RATIONALE: How nasal symptoms in patients with COPD change over time and resolve during natural occurring exacerbation have never been described. METHODS: Patients in the London COPD cohort were asked about the presence of nasal symptoms (nasal discharge, sneezing, post-nasal drip (PND), blocked nose and anosmia) over an 8-year period (2005-2013) every three months at routine clinic visits at stable state and daily during exacerbations with the use of diary cards. Data was prospectively collected and in a subgroup of patients COPD Assessment Test (CAT) and human rhinovirus (HRV) identification by PCR was available. Patients were also defined as infrequent/frequent exacerbators (<2 or ≥2 exacerbations/year). RESULTS: On 4368 visits, 209 patients with COPD were asked about their nasal symptoms. On 2033 visits, when the patients were stable, the odds ratio (OR) for nasal discharge increased by 1.32% per year (95% CI 1.19-1.45; p<0.001); sneezing 1.16% (1.05-1.29; p=0.005); PND 1.18% (1.03-1.36; p=0.016) and anosmia 1.19% (1.03-1.37; p=0.015). At exacerbation, nasal discharge was present for 7-daysand blocked nose, sneezing and PND increased for just 3 days; anosmia did not change. Nasal discharge was more likely in frequent exacerbators; OR 1.96 (1.17-3.28; p=0.011) and when present, CAT scores were higher by 1.06 units (0.32-1.80; p=0.005) when stable and 1.30 units (0.05 to 2.57; p=0.042) at exacerbation. CONCLUSION: Upper airway symptoms increase over time in COPD patients and are related to the frequent exacerbator phenotype. These longitudinal changes may be due to increasing airway inflammation or the disease progression.