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Purpose: Chronic obstructive pulmonary disease (COPD) poses a significant global health burden despite being largely preventable and treatable. Despite the availability of guidelines, COPD care remains suboptimal in many settings, including high-income countries (HICs) and upper-middle-income countries (UMICs), with varied approaches to diagnosis and management. This study aimed to identify common and unique barriers to COPD care across six countries (Australia, Spain, Taiwan, Argentina, Mexico, and Russia) to inform global policy initiatives for improved care., Methods: COPD care pathways were mapped for each country and supplemented with epidemiological, health-economic, and clinical data from a targeted literature review. Semi-structured interviews with 17 respiratory care clinicians were used to further validate the pathways and identify key barriers. Thematic content analysis was used to generate the themes., Results: Six themes were common in most HICs and UMICs: "Challenges in COPD diagnosis", "Strengthening the role of primary care", "Fragmented healthcare systems and coordination challenges", "Inadequate management of COPD exacerbations", "Limited access to specialized care" and, "Impact of underfinanced and overloaded healthcare systems". One theme, "Insurance coverage and reimbursement challenges", was more relevant for UMICs. HICs and UMICs differ in patient and healthcare provider awareness, primary care involvement, spirometry access, and availability of specialized care. Both face issues with healthcare fragmentation, guideline adherence, and COPD exacerbation management. In addition, UMICs also grapple with resource limitations and healthcare infrastructure challenges., Conclusion: Many challenges to COPD care are the same in both HICs and UMICs, underscoring the pervasive nature of these issues. While country-specific issues require customized solutions, there are untapped possibilities for implementing global respiratory strategies that support countries to manage COPD effectively. In addition to healthcare system-level initiatives, there is a crucial need for political prioritization of COPD to allocate the essential resources it requires., Competing Interests: Orjola Shahaj, Anne Meiwald, Krishnan Puri-Sudhir, Rupert Gara Adams, and Elisabeth Adams worked at Aquarius Population Health at the time of the project. Aquarius Population Health receives consultancy and research fees from other pharmaceutical and MedTech companies that are unrelated to this work. Abelardo Elizondo Rios has served on boards for trials sponsored by AstraZeneca, Bayern, Novartis and GSK. Alexis Cazaux has no conflict of interest concerning the topic of this research. Outside of the submitted work, Sergey Avdeev reports receiving consulting fees and/or fees for attending lectures, meetings and conferences and/or travel expenses and/or research grants from AstraZeneca, Novartis, GSK, Teva, Sanofi, and Chiesi. Peter Wark has no conflict of interest concerning the topic of this research., (© 2024 Shahaj et al.)