INTRODUCTION: Despite the high prevalence, morbidity and mortality of COPD, remarkably little is known about its impact on health care costs and utilization of services. Information about health care utilization and costs among patients with Chronic Obstructive Pulmonary Disease (COPD) is needed to improve care and for appropriate allocation of resources. OBJECTIVE: The purpose of this study was to quantify the burden of illness in Italy, in terms of both medical consumption and lost productivity associated with COPD. METHODS: Design: In 1998 an epidemiological study was conducted in Italy. Retrospectively, from a community perspective, we quantified COPD’s costs related both with health care consumption and lost of productivity and/or school days. Main Outcomes Measures: The main goal of the present study was to evaluate economic outcomes in a cohort of 355,000 patients with current diagnosis of COPD. RESULTS: As reported in previous studies, prevalence rate for COPD in Italy is about 4,6% (2,637,000 subjects). Among all COPD patients, 42,5% suffers from mild disease while 56,7% is affected by moderate-severe COPD, on the basis of Flow Expiratory Value (FEV1) % of predicted criteria. The total cost of COPD we have quoted is the sum of direct and indirect costs: it is worth US$18 billion, equal to US$6,843 average/patient/year. We have not included intangible costs because they cannot be quantified correctly as yet. CONCLUSIONS: COPD is associated with significant both direct and indirect costs. Previous studies reported that prevalence figures for COPD based on recorded diagnoses are underestimated. Notwithstanding, data from our study suggest that when patients seek medical advice they were correctly diagnosed and treated. Education of patients will allow them to take control of their disease and of costs related to COPD.