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Chronic obstructive pulmonary disease (COPD) is an increasing cause of morbidity and mortality worldwide. Although COPD has historically been considered a disease of white male smokers, it now clearly impacts both sexes and all races, with mortality rising fastest in women and African–Americans. Given the scarcity of data about non-African–American minorities, this review will focus on the disparities in COPD susceptibility, diagnosis, and treatment between men and women and between African–Americans and whites.Although the changing epidemiology of COPD in part reflects the changing epidemiology of cigarette smoking, there are data suggesting that women and African–Americans may be particularly susceptible to tobacco smoke and that the diagnosis, treatment, and natural history of the disease are influenced by race and sex.The possibility that sex or race or both, may influence COPD susceptibility and progression is of critical importance, and may mean that the potential future impact of the disease has been underestimated. Unfortunately, our understanding of these differences and the efficacy of standard COPD treatments in women and minorities remains limited by the low enrolment in clinical trials.