OBJECTIVES: Chronic obstructive pulmonary disease (COPD) remains a major public health problem in Japan. The aim of the study was to estimate healthcare resource use and the costs associated with COPD in a real-world setting. METHODS: A 2 years retrospective chart review was conducted in 18 sites distributed across Japan, including patients  > 40 years with spirometry confirmed COPD, and current or former smokers. Patients had to have available medical chart in the participating center for at least the previous 24 months with a minimum set of information. Patients having participated in a clinical trial during the previous 24 months were excluded.   Demographic, COPD related clinical data and healthcare resource use (hospitalization, consultations, medication and visit to emergency room) were obtained from clinical charts.  RESULTS: A total of 71 patients <65 years old and 151 patients ≥65 years old were included, of whom 84.5% and 95.4% were males, respectively. At inclusion the mean (SD) FEV1/FVC ratio was 0.5 (0.1) and 0.5 (0.2) for patients < 65 and ≥65 years respectively. During the 2 year review period, 77,5% of patients <65 years visited a respiratory specialist with a mean (SD) of 16,27 (8,47) visits. In the ≥65 years age group, 77.5% of patients had at least 1 visit to a respiratory specialist, with a mean (SD) of 20.81 (10.87) visits. The mean (SD) length of stay upon hospitalization (days per patient) was found to be 16.67 (13.84) and 18.03 (12.40) in the <65 years and ≥65 years age groups, respectively. The mean (SD) annual cost per patient in the <65 years and ≥65 years age groups was ¥438,976 (534,379) [US$ 4,390 (5,344.)] and ¥467,872. (606,121.) [US$ 4,677(6,061)], respectively. CONCLUSIONS: COPD represents an important burden on health care system in Japan.