Objectives: The aim of this study was to investigate the prevalence and load of airway bacteria in chronic obstructive pulmonary disease (COPD) patients and to detect the antibiotic susceptibility pattern of the isolated strains. Methods: The current study included 50 COPD patients. Paired sputum samples were taken from all patients, one at the exacerbation state and the other at the stable state. Identification of bacterial species was done using standard microbiological techniques and PCR. Results: There were 41 samples out of 50 (82%) positive for bacteria at exacerbation compared with 12 samples out of 50 (24%) positive for bacteria (either by culture or PCR or both) at stable state samples (p=0.001). The most commonly detected species was H. influenza and S. pneumoniae. There were a total of 27 bacterial species detected by PCR not detected by culture and only 4 bacterial species detected by culture not detected by PCR (p=0.001). Isolated strains show a high resistance pattern to the tested antibiotics and multi drug resistant strains were detected. Conclusions: This study has shown that airway bacterial prevalence and load increase at COPD exacerbations, and there is a significant relationship between lower airway bacterial colonization and COPD.