OBJECTIVES: To compare generic (EQ-5D, SF-12) and disease-specific (SGRQ) instruments for measuring the impact of severe acute exacerbations on quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) treated in hospital with regard to acceptance, ceiling effects, sensitivity to change and discrimination between groups with different disease severities. METHODS: Patients treated for acute exacerbations of COPD in the Asklepios-Fachkliniken München-Gauting, Germany, were asked to complete the questionnaire at admission and again before discharge. Information about patients’ age, sex, smoking status and disease severity according to GOLD classification was collected and EQ-5D, SF-12 and SGRQ were answered as self-administered questionnaires. Utility values were calculated for the EQ-5D and the SF-12 based on published utility weights. For the SGRQ, impact, symptom, activity and total scores were calculated. T-tests were conducted to compare proportions of missing values and sensitivity to change. The impact of different GOLD stages on QoL was assessed using linear mixed models. RESULTS: Preliminary analyses showed the highest acceptance for the EQ-5D, with the lowest percentage of missing utility values. No ceiling or floor effects occurred for the SF-12, whereas the SGRQ showed floor effects particularly for the dimension activity at both time points. Ceiling effects occurred for the EQ-5D at discharge. Sensitivity to change was highest for EQ-5D and SGRQ, whereas only minor changes were observed for the SF-12. However, differences between GOLD stages after adjusting for age and sex were best captured by the SF-12. CONCLUSIONS: The main problem of the SF-12 and the SGRQ is the high proportion of missing values although the former differentiates best between GOLD stages. The EQ-5D seems well suited for this patient group, yet ceiling effects pose a problem with this severe disease.