Patients with more severe chronic obstructive pulmonary disease (COPD) are more likely to have worse quality of life, higher BODE quartile and more exacerbations. A link, not hitherto acknowledged in West Indian patients, between COPD severity and depression is explored. The study shows for the first time a relation between the BODE index and low socio-economic status. The study recommends that all tertiary care patients with COPD should have regular vaccination, depression and six-minute walk assessment, and that health education in COPD should be aimed at those of low socio-economic status in particular.