OBJECTIVES: Chronic Obstructive Pulmonary Disease (COPD) poses a significant burden on healthcare budgets. The impact of impaired and lost productivity is less known. The aim of this study was to explore the economic burden of COPD in patients of working age in The Netherlands across three areas: healthcare utilization, impaired productivity and lost productivity resulting from early retirement due to COPD. METHODS: Dutch direct medical costs were derived from a literature review and applied to individual COPD patients. Costs of productivity impairment due to COPD were estimated from the ‘COPD uncovered’ survey, adopted for The Netherlands. Costs due to lost productivity due to early retirement were based on a cohort of COPD patients of working age followed in a Markov model for 20 years until (early) retirement or death. The costing year was 2011. RESULTS: The annual healthcare costs for patients with COPD aged 45-64 years in The Netherlands were estimated at around €70 million. The annual impaired productivity costs were €120 million. Lost productivity due to early retirement were estimated at around €510 million per year; the majority of €350 million for men and €160 million for women. These lost productivity costs represented 21% of the productivity that may have been generated by COPD patients if they had not retired early. CONCLUSIONS: The ‘COPD UNCOVERED' model was used to estimate the economic burden of COPD in The Netherlands. Costs due to impaired and lost productivity in COPD patients of working age was considerable and several times higher than the medical cost of COPD. Young working population provide a main target for interventions aimed to improve COPD disease management.