An economic analysis of data from a large-scale international survey, Confronting COPD in North America and Europe, was conducted in seven countries (Canada, France, Italy, The Netherlands, Spain, the U.K and the U.SA.), to investigate the burden of chronic obstructive pulmonary disease (COPD). The results demonstrated the high economic impact of COPD on the healthcare system and society in each country. The mean annual direct costs of the disease were particularly high in the U.S.A. (US dollar 4119 per patient) and Spain (US dollar 3196 per patient) but relatively low in The Netherlands (US dollar 606) and France (US dollar 522). Lost productivity due to COPD had a particularly high impact on the economy in France, The Netherlands and the U.K, accounting for 67%, 50% and 41% of overall costs, respectively. The total societal cost of COPD per patient ranged from over US dollar 5646 in the U.S.A. to US dollar 1023 in The Netherlands. In five out of seven countries, the majority (52-84%) of direct costs associated with COPD were due to inpatient hospitalizations. As acute exacerbations of COPD are a key driver of secondary care costs, interventions aimed at preventing and treating exacerbations effectively could significantly reduce the economic impact of this disease. In all of the participating counties, COPD was underdiagnosed and undertreated. Between 9% and 30% of patients were undiagnosed despite having symptoms consistent with COPD, and up to 65% of patients did not receive regular prescribed medication. Patients reported poor symptom control and considerable use of healthcare resources. Therefore, reducing the burden of COPD will involve better evaluation and diagnosis of patients with COPD, as well as improved management of chronic COPD symptoms by healthcare professionals. The survey also demonstrated that the societal costs of COPD were 4-17 times higher in patients with severe COPD than in patients with mild COPD. Patients with comorbid conditions (accounting for 30-57% of patients in each country) were also particularly costly to society. These results suggest that a high priority should be given to interventions aimed at delaying the progression of disease, preventing exacerbations and reducing the risk of comorbidities, in order to alleviate the clinical and economic burden of COPD in North America and Europe.