Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease associated with substantial morbidity and mortality. COPD exacerbations (worsening of symptoms) can lead to hospital admissions. One of the treatment goals in managing COPD is to reduce the exacerbation rates, since these rates affect the patient's quality of life, drive up treatment related costs, and if untreated could lead to decreased survival rate. A study of trends in COPD exacerbations is important for several reasons. First, by examining trends, we may determine whether recent treatment methods and disease relevant policies are effective. Second, by identifying disparities in exacerbation rates, health care professionals may be able to direct more efforts toward populations with the highest rates. Third, an analysis of trends will inform researchers on the progress of COPD research. In this study we explored the change in race specific rates of COPD exacerbations according to county metropolitan status among the Texas population from 2001 to 2009.