Objective. This study describes mortality associated with chronic obstructive pulmonary disease (COPD) in France using multiple causes of death. Methods. The analysis focused on deaths among adults aged 45 years or older in metropolitan France between 1979 and 2003 that listed COPD as the primary or contributing cause (COPD-related deaths). Due to the implementation of ICD-10 in 2000, two periods were distinguished: 1979–1999 and 2000–2003. Age-standardized annual mortality rates were calculated. Results. In 2000–2003, an average of 15,349 deaths per year involved COPD, with half of these deaths listing COPD as the primary cause. When COPD was listed as a contributing cause, the most common primary causes were cardiovascular diseases (32%) and cancers (24%). Between 1979 and 1999, the age-standardized annual mortality rate for COPD increased among women (+1.7% per year) but has remained stable since 1986 among men. In 2000–2003, for both men and women, the average rates in northern and eastern France, as well as in Brittany, were higher than the national average. Conclusion. COPD-related mortality remains underestimated given the extent of underdiagnosis of this disease. It is likely to continue increasing among women in the coming years. Significant regional disparities are observed, which likely reflect differences in risk factors.