COPD is a major cause of morbidity and mortality in Europe. The purpose of this literature review was to critically evaluate published data on COPD prevalence and the cost of COPD interventions in European countries. Selection of literature was based on article retrieval from a systematic literature search using PubMed and EMBASE. Only articles providing data in European countries published between January 1990 and March 2003 were included. European epidemiological (cross-sectional, cohort, case-control) and economic (cost-of-illness-, cost-minimization-, cost-effectiveness-, cost-benefit-, cost-utility-analysis) studies were included. Of 74 retrieved epidemiologic studies, only seven (9%) fulfilled the inclusion criteria. In the selected literature, COPD prevalence ranged from 3% among Finnish women to 57% among Italian men and women, 45 years and older. Of 56 economic studies, 24 satisfied entry criteria. Results from the final cost-of-illness studies indicated that hospital care and medication represented the major portion of costs associated with COPD. In a survey conducted in 1998/99, annual direct expenditures for COPD treatment per patient in Europe ranged from Euro 530 in France to Euro 3238 in Spain. There was a differential increase in COPD prevalence predominantly related to an aging patient population, with a high incidence of exposure to cigarette smoke. Data also showed differences in the economic impact of COPD in Europe based on the proportion of patients with severe COPD, frequency of exacerbations, and number of hospitalizations. Overall, results of this review demonstrated the need for global epidemiologic and economic studies to allow for more uniform guidelines for the prevention and cost-effective treatment of patients with COPD.