OBJECTIVES: Chronic disease imparts significant disability, premature mortality and economic burden on countries. Chronic obstructive pulmonary disease (COPD) will be the fifth leading cause of disability-adjusted mortality in 2020. Causative exposures include tobacco smoke, biomass fuels, occupational and other environmental factors. The Burden of Obstructive Lung Disease (BOLD) project will estimate the prevalence and burden of COPD globally. Here, we on the design, development and application of a population simulation model to forecast country-specific economic burden of COPD. To show feasibility of the model, we report US burden data. METHODS: A publicly available population simulation model was developed to estimate annual and future mortality and costs. The model reflects changes in the size, composition and population demographics of the jurisdiction. Input data include disease prevalence from the BOLD COPD epidemiology studies, tobacco smoking and cessation rates, background mortality, disease attributable mortality, annual incidence of COPD, lung function progression data from the Framingham Heart Study and costs. Simulations are based on a starting cohort age 20 years and older in 2005. Five, 10 and 20-year projections are discounted at 3% per year. RESULTS: The model projects COPD prevalence to increase each year. In 2005, the projected cost of COPD in the US was $51.4 billion in medical expenses or $256 per capita. Cumulative discounted 5, 10 and 20 year medical costs for COPD were $304.9 billion, $678.4 billion and $1,415.3 billion. CONCLUSIONS: COPD is one of the world's leading causes of disability and mortality. The economic consequences of tobacco use and occupational exposures leading to COPD are substantial. We developed this model as part of a global burden identification and reduction project. Here, we show its application for burden simulation with US data, but intend a larger global effort in conjunction with the BOLD project.