To study beliefs about smoking and COPD, and motivation for smoking discontinuation we recruited 100 COPD patients during admission for exacerbation. They were asked about motivation to quit smoking and about disease understanding. We compared their survival with that of 324 COPD patients and with survival of age-matched Danes. Forty-five smokers, 50 ex-smokers and five never-smokers were included. Mean value of age was 77.5 years, number of years smoking was 51.8, and FEV1 was 0.79 L. Most patients were not certain about the association between smoking and COPD. Only 16% thought that their smoking had caused COPD and 24% thought that they would not suffer from COPD, had they not smoked. Three out of the six motivation questions could be included in a mutual quantitative scale (alpha = 0.76). Thirty per cent (r = 0.55, p = .005) of the variation in the motivation scale score was explained by number of years with smoking (negative association), number of cigarettes smoked per day (positive association) and BMI (negative association). Mortality was lower than in the reference population (RR = 0.63, p = .005), but higher than in age-matched Danes. Many patients are not certain about the association between smoking and COPD. We developed a smoking cessation motivation scale based on three questions.