OBJECTIVES: To systematically assess the global economic burden associated with symptomatic COPD. METHODS: A systematic search of Embase®, MEDLINE®, EconLit® and LILACS® was conducted for last 10 years along with search of conference proceedings for last 3 years. Non-randomised trials and observational studies involving symptomatic patients defined as modified Medical Research Council (mMRC) score ≥2 or COPD assessment test (CAT) score ≥10 or presenting common symptoms of COPD were included.  Studies focussed on cost of illness and resource use in adult symptomatic COPD patients were included. Studies meeting the eligibility criteria were appraised using Drummond checklist. RESULTS: Database searches yielded 4491 references which resulted in 74 relevant studies after two levels of screening. All the included studies were of adequate reporting quality with study objective and competing alternatives being defined clearly. The annual direct per patient costs of COPD ranged from US$522 in France to US$4119 in the USA. Physician consultations were the most frequently utilised resource, followed by ER visits and hospitalisations. The composition of direct costs differed between countries, with more than 50% of the direct costs resulting due to inpatient admissions in Canada, Italy, Spain, the UK, and the USA and almost 50% due to regular prescribed medicines in The Netherlands. The mean annual societal costs ranged from US$1023 in The Netherlands to US$5646 in the USA. The annual societal costs per patient were higher in patients with severe COPD, higher levels of dyspnoea and symptoms, frequent exacerbations, comorbid conditions, low educational status and former smokers. Economic burden of lost productivity was the highest in the US and the lowest in Italy. Lost productivity accounted for 67% of the total cost of COPD in France. CONCLUSIONS: The management of symptomatic COPD is associated with a substantial economic burden, especially in the developed nations of Europe and North America.