Background: Exacerbations of chronic obstructive pulmonary disease (COPD) may increase the risk of morbidity and mortality as well as pulmonary complications after surgery among patients with COPD. This meta-analysis was designed to explore the impact of moderate and severe exacerbations of COPD on health-related quality of life (HRQoL), utility, and lung function in patients with COPD. Methods: The individual impacts of moderate and severe exacerbations on St George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), and EuroQoL-5 dimensions 5 level (EQ-5D-5L) scores, and on forced expiratory volume in 1 s (FEV1) were assessed. Adjustments were applied to account for differences in study design. Outcomes were measured at specific time points across a 12-month study period, for all patients and for subsets with either no or >= 1 severe exacerbations in the year before study entry. The proximity of each measurement in relation to a specific exacerbation was also assessed. Results: A total of seven randomized clinical trials (RCTs) >= 12-month interventional/observational studies with 18,746 COPD patients were assessed. Overall, 4,483 (24%) patients had >= 1 severe exacerbation in the previous year. Moderate and severe exacerbations were associated with worsening from baseline in SGRQ, CAT, EQ-5D-5L, and FEV1 measures; severe exacerbations had greater impact than moderate exacerbations. Conclusions: Moderate and severe exacerbations have a substantial and lasting impact on HRQoL, utility, and lung function in patients with COPD, highlighting a need for effective exacerbation prevention.