Introduction Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Long-term trends describing the hospital burden of COPD are sparse.

Methods A retrospective cohort study using the Scottish Morbidity Record Scheme. First and subsequent hospitalisations for COPD in Scotland (1991–2009) were identified. Age standardised hospitalisation rates were calculated. Age and sex-specific trends in first and subsequent hospitalisation were modelled (Joinpoint regression).

Results There were 63 996 first hospitalisations for COPD (1991–2009). Over time the rate of first hospitalisation fell in men and remained stable in women >55 years old, but rose in both men and women 35–54 years old. In total 64 942 individuals contributed to 185 200 readmissions. Readmission rates increased in men aged 35–54 years and >75 years old. A trend towards falling readmission rates in men aged 55–74 years, in whom the burden of COPD is greatest, was observed. In women, rates of readmission increased in all age groups. However the rate of increase slowed in those aged 55–84 years in the latter period of the study.

Conclusions The hospital burden of COPD is high and driven by readmissions. Our data suggest that the COPD epidemic may be approaching a peak. However, incident hospitalisation for COPD in men and women 35–54 years old are increasing and as survival following an incident COPD hospitalisation improves and the population ages, the absolute number of hospital admission for COPD will increase. Alternates (cost-effective) models to hospital care are urgently required to meet this demand.