METHODS: We performed a retrospective chart review of patients with a new diagnosis of COPD, Emphysema or Chronic Bronchitis (ICD-9 491.2, 491.9, 492.8) seen in the primary care practice of Tufts Medical Center from 2001 through 2016. Diagnostic accuracy was determined using clinic notes, pulmonary function testing and chest imaging. Patients were divided into two groups using Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria: COPD and Indeterminate. The COPD group included patients with one or more of the following: an obstructive ventilatory defect on spirometry, radiographic evidence of emphysema, a clinical history consistent with chronic bronchitis. Patients lacking these criteria were Indeterminate. Clinical and diagnostic covariates including age, gender, BMI, comorbidities, smoking history, frequency of pulmonary function testing (PFTs) and pulmonary consultation were compared between the two groups. Data were summarized using means (standard deviations) and n (%) where appropriate. Chi-square and T-test were used for between group comparisons.