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Objective: To assess cough peak flow in patients with frequent infective exacerbations of COPD. Design: Cross-sectional controlled clinical study. Settings: Pulmonary function laboratory of the Chest Department of Ain Shams University Hospitals, Cairo, Egypt. Patients: Forty male patients with severe COPD; twenty with stable disease and twenty with more than two exacerbations in the last year were included in the study. Interventions: Spirometry and cough peak flows were measured at least six weeks after recovery from their last exacerbation. Results: Both groups were matched as regards demographics and lung functions. There was a statistically significant lower CPF in the frequent exacerbation group. Conclusion: Cough peak flow can guide respiratory physicians in fine tuning the management of patients with severe COPD to their particular needs.