OBJECTIVES: Respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), cause about 1 million deaths annually in the WHO European Region. Xanthines (e.g. theophylline, aminophylline) are recommended for treating severe exacerbations of COPD, when short-acting bronchodilators do not produce adequate response. The aim of this study was to compare use of xanthines in the treatment of chronic respiratory diseases between Serbia and the Scandinavian countries in the period from 2004 to 2013.  METHODS:  The data on utilization of drugs for obstructive airway diseases (ATC group R03) during the ten-year period (2004-2013) were retrieved by a retrospective, observational, population-based study, from the Medicines and Medical Devices Agency of Serbia, Finnish Medicines Agency Fimea, Danish Statens Serum Institut and Norwegian Institute of Public Health. ATC/DDD methodology was applied and the results were expressed in defined daily doses per 1000 inhabitants per day (DID).  RESULTS: While the utilization of xanthines (R03DA) showed a significant tendency to decrease in all Scandinavian countries during the whole observed period of time (4.4-fold in Denmark, 3.46-fold in Norway and 2.38-fold in Finland), in Serbia on the other hand, xanthines represented the most used drugs in the R03 group, with no clear decrease tendency. In 2013, xanthines accounted for less than 2% of total use of drugs in R03 group in Finland, Norway and Denmark (1.25 DID, 0.61 DID and 0.50 DID, respectively), versus 26% (7.11 DID) in Serbia. CONCLUSIONS: The large differences in utilization of xanthines between Serbia and other observed countries may suggest considerable lower number of exacerbations of COPD in the Scandinavian countries due to better control of chronic respiratory diseases. Acknowledgement: This work was supported by the Provincial Secretariat for Science and Technological Development, Autonomous Province of Vojvodina, project No. 114-451-2458/2011 and by the Ministry of Education, Science and Technological Development, Republic of Serbia, project No. 41012.