Chronic obstructive pulmonary disease (COPD) is primarily a disease of the elderly with increasing worldwide morbidity and mortality. Goals of treatment are to relieve symptoms, reduce airflow obstruction, and improve functioning. Although current treatment strategies and guidelines for long-term COPD management recognize bronchodilators as first-line therapy for all patients, inhaled corticosteroids are prescribed for some patients. OBJECTIVE: To characterize COPD medication prescribing patterns among visits of patients >=65y across US ambulatory care centers. METHODS: Data from the 2002 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey gathered from physician offices, hospital outpatient, and emergency departments were analyzed for patients >=65y. COPD visits were identified by primary diagnoses of bronchitis, chronic bronchitis, emphysema, or chronic airway obstruction. Patients with coexisting asthma were excluded. Sample data were weighted to provide national estimates. RESULTS: In 2002, COPD accounted for 7.7 million ambulatory care visits among patients >=65y. Of these visits, 54.6% were by females and 93.0% were by white patients. COPD medications were prescribed at 38.7% of visits with an average of 1.8 COPD medications prescribed per visit. Bronchodilators, alone or in combination, were prescribed at 2.0 million visits, representing 26.5% of visits. Prescribed bronchodilators were short-acting beta-agonists (16.4%), anticholinergics (11.8%), methylxanthines (7.5%) and long-acting beta-agonists (4.8%). Inhaled corticosteroids, alone or in combination, were prescribed at 13.4% of visits. The most commonly prescribed COPD medication combination was short-acting beta-agonists with anticholinergics (6.9%). CONCLUSION: Ambulatory care center prescribing patterns suggest that COPD medications may be under-prescribed in elderly patients. Bronchodilators appear to be the most common COPD-specific treatment. The frequency with which short-acting beta-agonists and anticholinergics were prescribed concurrently in this dataset may indicate a deficiency in acceptable therapies that provide sufficient bronchoconstriction relief. Further research is needed to assess optimization of drug management for elderly COPD patients.