OBJECTIVES:  Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease, mainly caused by smoking or air pollution. Worldwide COPD affects nearly five percent of the global population and is considered as the fourth leading cause of death. In the last years various new COPD therapies have been developed and launched in Europe. A key question remains if these new therapies reach patients in various European countries. METHODS:  The international HTA Prismaccess database includes all decisions by market access authorities, among others France, Germany, the Sweden and the UK. All decisions on therapies for COPD and asthma launched in these countries since 2011 were considered for a systematic analysis. RESULTS:  In total there were 71 decisions considered. France with the Transparency Committee is leading with 27 decisions, followed by Sweden’s TLV and the Scottish SMC with 17 each, German’s G-BA follows (8) before UK’s NICE (2). The level of added benefit differed from insufficient, restricted and recommended without limitations within and between countries. More positive was France, 13 recommended without limitations, 2 restricted and 12 insufficient decisions; SMC with 12 recommended without limitations, 3 restricted and 2 insufficient; and TLV with 14 recommended without limitations and 3 restricted. Less positive, NICE evaluated two drugs as recommended with limitations. In Germany the G-BA evaluated 8 drugs: Four therapies received no added benefit and four received an added benefit in at least one subgroup. Six treatments decisions of the respective HTA bodies differed in the results. CONCLUSIONS:  The analysis showed differences in the assessment of COPD and asthma drugs between different market access authorities in Europe. Reasons vary hugely and need to be taken into account in future market access submissions.