Alcohol consumption shows a U-shaped relation with all-cause and cardiovascular mortality. To determine whether a similar relation exists between alcohol and chronic obstructive pulmonary disease mortality, we analyzed data on alcohol consumption in 1970 and 20-year mortality from chronic obstructive pulmonary disease among 2,953 middle-aged men from Finland, Italy, and the Netherlands. We also studied alcohol consumption in relation to pulmonary function (FEV1 or FEV0.75) at baseline. We used regression models adjusted for age, height (for pulmonary function only), body mass index, smoking habits, energy intake, and country. A smoothed spline-plot showed a U-shaped relation between alcohol and chronic obstructive pulmonary disease mortality. Compared with non-drinkers and occasional drinkers, the relative risk of chronic obstructive pulmonary disease mortality was 0.60 (95% CI = 0.33-1.09) in light drinkers (> 1 drink per week, < or = 3 drinks per day) and 1.25 (95% CI = 0.47-3.31) in moderate-to-heavy drinkers. Pulmonary function was lower in non-drinkers compared with occasional and light drinkers in Finland (75 ml, 95% CI = -2 to 151) and the Netherlands (93 ml, 95% CI = 0-186) and lower in very heavy (> 12 drinks per day) compared with moderate-to-heavy drinkers in Italy (99 ml, 95% CI = 9-189). In conclusion, we observed a U-shaped curve between alcohol consumption and 20-year chronic obstructive pulmonary disease mortality in middle-aged men that was supported by cross-sectional data on alcohol and pulmonary function.