COPD is a disease that can adversely affect patients' psychology. The purpose of this study is to investigate whether COPD patients feel increased hostility, and if hostility is associated with socio-economic factors. A cross-sectional study was conducted in 203 COPD patients in primary health care services in Greece, using the hostility and direction of hostility questionnaire HDHQ. Patient demographics, smoking habits, body mass index (BMI) and disease grade were also recorded. The results showed significant differences between males and females, with women exhibiting higher hostility (p = 0.004). Age correlates negatively with hostility, with younger patients showing higher values. Patients who continue to smoke (p = 0.005), and those in a very poor financial situation, have a much higher level of hostility. Regarding family status, married patients show the least hostility. In patients with very severe COPD and those with low education (p = 0.035) there is a high level of self-criticism. In conclusion, patients with COPD, still smokers, single, low-income and low-educated, especially female patients, have a higher risk of developing hostility. These findings suggest a need for further research in order to clarify the complexity of the different risk factors.