Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a leading cause of hospital admission and mortality in India, yet hospital-based data on clinical profiles and modifiable risk factors remain limited. Objective: To characterise the clinical profile of patients admitted with AECOPD and to identify risk factors associated with exacerbation severity and adverse outcomes. Methods: A hospital-based observational study was conducted at TRR College of Pharmacy over five months (August–December 2019), enrolling 48 patients with spirometry-confirmed COPD admitted with AECOPD. Demographic, clinical, laboratory, and microbiological data were collected using a predesigned proforma. Exacerbation severity was graded using GOLD 2023 criteria. Results: The mean age was 63.4 ± 9.8 years, and 79.2% were male. Breathlessness (100%), productive cough (85.4%), and fever (75.0%) were the predominant symptoms. Current or ex-smoking was reported by 81.3%, biomass fuel exposure by 35.4%, and prior pulmonary tuberculosis by 22.9%. Elevated CRP (>6 mg/L) was present in 87.5%, and sputum culture was positive in 58.3%, with Pseudomonas aeruginosa (32.1%) and Klebsiella pneumoniae (21.4%) predominating. Frequent exacerbators (≥2 in the preceding year) constituted 41.7% and had significantly higher CRP (p = 0.012), lower FEV₁% predicted (p = 0.008), and longer hospital stay (p = 0.003). Conclusion: AECOPD in this cohort was characterised by advanced age, male predominance, high infective burden, and substantial exposure to non-smoking risk factors including biomass fuel and prior tuberculosis. Frequent prior exacerbations, elevated CRP, and low FEV₁ were significant risk factors for adverse outcomes.