In 31 developed countries, chronic obstructive pulmonary disease (COPD) and allied conditions comprise a major cause of death, but they cause less than 10% of all deaths, even in older persons. COPD mortality is highest in the Eastern European countries and Ireland, Scotland, and England/Wales, and is lowest in southern Europe, Japan, and Israel. That these differences are large and real is a likelihood but not a certainty, due to problems in comparability of cause-of-death statistics. In the past, the trend in COPD mortality has been upwards. Over the short time period of 1980 to 1985, there have been substantial declines in death rates in most countries for the major causes of death, but not for COPD or lung cancer. It is not clear, however, whether COPD mortality is continuing to increase everywhere. In only nine countries is the trend upwards and only in women above age 55 and in men above age 75. In the other 22 countries, trends are not clearly upwards or downwards. Longer time trend statistics are needed to corroborate and explain these patterns and the apparent intercountry differences.