Objective: Chronic obstructive pulmonary disease (COPD) is a major burden to patients, caregivers, and physicians. The purpose of this focus group research was to identify and describe patients' and caregivers' perceptions on abilities to perform daily living activities, satisfaction with COPD management, and economic burden of the disease. Also, focus groups of physicians elicited similar information. Methods: Focus groups of patient/caregiver pairs, patients, caregivers, primary care physicians (PCPs) and pulmonologists were conducted in two states. Patients recruited had a live-in caregiver and had been diagnosed with COPD for =1 year, caregivers attended to their patients for =1 year, and PCPs and pulmonologists saw at least 10 COPD patients per week. Focus groups were 90-120 minutes and were conducted by trained focus group moderators. Results: Seventeen patients, 17 caregivers, 12 PCPs, and 8 pulmonologists participated in the focus groups. COPD patients in New Jersey (NJ) reported receiving better care, seeing specialists more often, and having better access to pulmonary rehabilitation than patients in Florida (FL). Only one-third of FL patients had a spirometry test during their last physician visit, compared to half of NJ patients. Patients treated by PCPs reported having inadequate appointment time and feeling like a burden to their physician. Patients and caregivers described difficulties in the daily lives of patients including social interactions, household chores, and bathing. Economic burden identified included inability to work and high co-pays. PCPs reported that depression and anxiety are commonly observed in COPD patients. Awareness of COPD treatment guidelines was greater among pulmonologists than PCPs. Conclusion: Patient and caregiver perceptions of COPD care demonstrate the need for improvement in the management of COPD. Medical care differences among physicians suggest a need for better dissemination of treatment guidelines. A national survey will generate quantitative findings regarding the evolving treatment of COPD.