OBJECTIVE: To assess the discriminative properties of the EQ-5D with respect to COPD severity according to GOLD in a large multinational study. METHODS: Baseline EQ-5D Visual Analogue Scale (VAS) scores, EQ-5D utilities and SGRQ scores were obtained from a subset of patients in the UPLIFT trial, a 4-yr placebo-controlled trial of tiotropium in COPD patients aged ≥ 40, FEV1 % pred<70, FEV1/FVC≤70% and ≥10 pack years of smoking to assess the rate of decline in FEV1. RESULTS: 1,235 patients (mean post bronchodilator FEV1 % pred 48.77) from 13 countries completed the EQ-5D. EQ-5D VAS and utility scores differed significantly between GOLD stages 2, 3 and 4, also after correction for age, sex, smoking, BMI and co-morbidity (p<0.001). Mean (SD) EQ-5D VAS scores in GOLD stages 2, 3 and 4 were 68 (16), 62 (17) and 58 (16), respectively. Mean (SD) utilities were 0.79 (0.20) in GOLD 2, 0.75 (0.21) in GOLD 3 and 0.65 (0.23) in GOLD 4. Effect sizes for the difference in utilities between GOLD 3 and 4 were more than twice as high as for the difference between 2 and 3. Gender, post-bronchodilator FEV1 % pred, number of hospital admissions and ER visits in the year prior to baseline, number of concomitant diagnoses and BMI were independently associated with EQ-5D utility. Danish, Spanish and Dutch patients had significantly higher utilities than US patients. French patients had lower utilities. Utilities calculated with the US value set were on average 5% higher than utilities calculated with the UK set. CONCLUSIONS: Increasing severity of COPD was associated with significant decline of EQ-5D VAS scores and utilities. These results demonstrate that a generic instrument can assess COPD impact on quality of life and that the scores discriminate between patients groups of known severity. These utilities will be useful in cost-effectiveness assessments.