OBJECTIVES: Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is a progressive chronic lung disease. The objective of this study was to estimate the burden of COPD patients on the Bulgarian society. METHODS: An observational inquiry cohort multi-centered study was performed among patients diagnosed with COPD in Bulgaria. Age and sex specific data for COPD prevalence, national smoking rates, and treatment costs were obtained from a prebuild questionnaire. The obtained data were processed statistically with Microsoft Excel and SPSS by applying descriptive analysis and comparative independent T test. All costs were measured using BGN (1 EUR = 1.95515 BGN) from the health care payer perspective. 426 patients were included. According to the National Health Insurance Fund for 2013 the number of patients diagnosed with COPD is 76 000 so these patients represent 0.56 %. RESULTS: CONCLUSIONS: The cost of COPD in Bulgaria is high and 85% is covered by the National health insurance Fund. The treatment with combined drugs (LABA/ICS) prevails even in mild and moderate COPD. The COPD drugs are with high percent of reimbursement, they are affordable thus suggesting better therapy adherence.