Background: COPD is a common disorder with a major public health burden. Although cigarette smoking remains a major contributor, there is increasing appreciation that household air pollution and environmental pollution may contribute further to COPD in the coming years. Aims and objectives: Using mathematical modeling, we sought to quantify and project the role of environmental risk factors and smoking from the perspective of their increasing burden on COPD within the context of exacerbations and financial costs. Methods: Using publicly available data for 12 countries, an open cohort Markov model was developed to simulate population dynamics from 2019 to 2050. Population growth was modeled across different subgroups of age, sex, and smoking status. COPD costs were calibrated across these subgroups, and distributions of COPD severity grades (GOLD criteria) were modeled based on smoking status, household air pollution, PM2.5, and ozone. Direct healthcare costs, indirect absenteeism costs, and numbers of exacerbations were projected to 2050. Costs were adjusted using USD conversion and Consumer Price Index 2019. Results: Results are presented in Table. Conclusions: We anticipate a major contribution of population growth, cigarette smoking, environmental pollution and indoor air pollution on COPD exacerbations and financial costs in Western Europe. Public health strategies should be focused accordingly. 

t=trillion, b=billion, m=million, PPPY=per patient per year