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BACKGROUND In chronic obstructive pulmonary disease (COPD), the "obesity paradox" is a phenomenon without a clear cause. The objective is to analyze the complications of COPD patients according to their body mass index (BMI). METHODS An observational study with a six-year prospective follow-up of 273 COPD patients who attended a spirometry test in 2011. Survival and acute events were analyzed according to the BMI quartiles. RESULTS A total of 273 patients were included. BMI quartiles were ≤24.23; 24.24-27.69; 27.70-31.25; ≥31.26. During