Although COPD is a debilitating pulmonary condition, many studies have shown awareness of the disease to be low. This article presents data on attitudes and beliefs about COPD in subjects with respiratory symptoms participating in the BREATHE study in the Middle East and North Africa region. This study was a large general population survey of COPD conducted in ten countries of the region (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), together with Pakistan, using a standardised methodology. A total of 62,086 subjects were screened, of whom 2,187 fulfilled the "epidemiological" definition of COPD. A detailed questionnaire was administered to these subjects, which documented knowledge about the disease, attitudes to care, beliefs about COPD and satisfaction with treatment. 1,392 subjects were analysable. Overall, 58.6% of subjects claimed to be very well or adequately informed about their respiratory condition. Two-thirds of subjects reported receiving information about COPD from their physician and 10.6% from television; the internet was cited by 6% and other health professionals or patient associations by <1%. Several inappropriate beliefs were identified, with 38.9% of respondents believing that there were no truly effective treatments, 73.7% believing that their respiratory condition would get progressively worse regardless of treatment and 29.6% being unsure what had caused their respiratory problems. Although 81% of respondents believed that smoking was the cause of most cases of COPD in general, only 51% accepted that it was the cause of their own respiratory problems. Treatment satisfaction was relatively high, with 83.2% of respondents somewhat or very satisfied with their physician's management, in spite of the fact that only 47.5% considered that their physician's advice had helped them manage their respiratory symptoms a lot. In conclusion, awareness of COPD in the region is suboptimal and treatment expectations are undervalued. Better patient education and more effective patient physician communication are clearly required. (C) 2012 Elsevier Ltd. All rights reserved.