The characteristics of Chronic Obstructive Pulmonary Disease (COPD) patients and the patterns of treatment have not been well characterized in primary care settings. Determining how drug treatment patterns align with COPD diagnosis and severity may help optimize care. OBJECTIVE: This study was designed to explore treatment patterns at the time of and post COPD diagnosis. METHODS: A national electronic medical record database was queried to identify patients with at least six-months history prior to a diagnosis of COPD (ICD-9 codes 491.xx, 492.xx, and 496). Pulmonary function test (PFT) results closest to the first diagnosis of COPD were evaluated to characterize disease severity using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Prescription data were evaluated at the time of diagnosis. All descriptive statistics were conducted using STATA statistical software. RESULTS: A total of 14,691 patients had COPD and six-months of data. Prescription data at diagnosis were available for 9334 (64%) of these patients. Of these, over 50% (n=5264) had a prescription on the date of diagnosis. The average number of days between diagnosis and the first prescription was 106 (SD+256.4). The beta-adrenergic class was the most commonly prescribed therapy (64%) post diagnosis. Only 273 (2%) of the 14,691 COPD patients had PFT data adequate to determine the GOLD severity class. For this group, the average time from diagnosis to first prescription was inversely related to severity: 163 (SD+288.2) days for Stage one and 124 (SD+152.3) days for Stage four. CONCLUSIONS: COPD is often not diagnosed or treated until the later stages of the disease, nor is PFT used routinely to diagnose, stage or guide treatment decisions. COPD severity seems to influence the time between the date of diagnosis and physician prescription order.