OBJECTIVE: To understand the hemoglobin (Hb) thresholds Pulmonologists (PULs) use to assess anemia severity in COPD. METHODS: A survey was conducted to identify Hb thresholds representing presence and severity of anemia in COPD. RESULTS: One hundred PULs completed the survey at a specialty society meeting in 2004. All were either board-certified or eligible in Pulmonary Medicine. Forty-seven percent have been in practice for <5 years, with 30% and 23% in practice for 5-15 years and >15 years, respectively. The vast majority (86%) see almost exclusively adult patients, 41% of the responders follow <250 patients, while 41% see 250-1000 and 12% see >1000 patients with lung disease. Responders estimated that COPD accounts for 49% of their lung disease patients, followed by asthma (24%), lung cancer (13%) and obstructive sleep apnea (13%). Only 21% of the PULs considered anemia to be Hb = 12g/dL. Furthermore, 37% of the responders considered Hb = 10g/dL to represent only mild anemia. Hb = 9g/dL was identified by 47% to represent moderate anemia, while Hb = 8g/dL was deemed to represent severe anemia by 75% of the responders. CONCLUSIONS: Despite the accepted WHO definition of anemia (men, Hb < 13g/dL; women, Hb < 12g/dL), the majority of PULs surveyed do not consider anemia to be present in COPD patients until the Hb is < 11g/dL, and a substantial number consider a Hb < 10g/dL as only mild anemia. Results of this survey suggest that PULs may not recognize mild anemia which could lead to severe anemia and other complications.