OBJECTIVES To heighten awareness of the changing demographics and health care use patterns of patients with COPD in Iowa. METHODS A retrospective cohort study of Iowa hospital and outpatient events associated with COPD was constructed from Iowa hospital discharge data.  Inpatient and outpatient events from 2006-2011 for persons 45 years of age and older were included if COPD was the principal diagnosis. Inpatient and outpatient event rates per 1,000 persons by sex were calculated for each observation year in Iowa. The changes in rates over time were estimated using ANOVA. RESULTS A total of 34,118 inpatient events studied; 17,866 (52.37%) were for women; 9,943(29.14%) were for persons under 65 years of age.  Of the 33,070 outpatient events studied, 16,200(48.99%) were for women; 13,308(40.24%) were for persons under 65 years of age. Annual inpatient event rates per 1000 persons were not significantly different across 6 years (P-value=0.30); outpatient event rates per 1000 persons significantly increased over time (P-value=0.0061). For inpatient and outpatient events, women had significantly lower rates per year (P-value<0.0001).  However, the gap between males and females narrowed over time for both types of events. The absolute difference in rates between men and women for inpatient events declined from 1.12 per 1000 persons in 2006 to 0.47 per 1000 persons in 2011. For outpatient events, the absolute difference in rates declined from 2.08 per 1000 persons in 2006 to 0.96 per ,000 persons in 2011. CONCLUSIONS There is a changing profile of COPD in Iowa. An increasing number of women and persons younger than 65 years of age experienced hospitalizations and outpatient visits.  Approximately one out of three COPD hospital events and two out of five outpatient events occurred among persons of working age (<65).  Greater emphasis should be given to the impact of the disease for women and the economic burden for the US work force.