Global Initiative on Chronic Obstructive Lung Disease (GOLD) guidelines recently removed stage 0, a group with symptoms but without airways obstruction, from their severity staging. However, in practice this group may still be diagnosed and medically managed. The aim of this study was to characterize healthcare utilization patterns of chronic obstructive pulmonary disease (COPD) patients by disease severity, focusing on the possible unique attributes of patients who would have been classified as GOLD stage 0. This is a prospective cohort pilot study performed at the Hines Veterans Administration Hospital. One hundred twenty patients with a diagnosis of COPD were enrolled. The participants completed quality-of-life questionnaires and a pulmonary function test. Healthcare utilization data were obtained 1 year prior and 2 years after the enrollment date. Three disease severity groups were defined based on GOLD criteria for comparison [GOLD stage 1-2 (GS 1-2), GOLD stage 3-4 (GS 3-4), and formerly GOLD stage 0 ("at risk")]. The "at risk" group had an average of 14.4 (SD = 30.5) outpatient visits/year and 0.3 (SD = 0.8) hospitalizations/year, which were higher than the other groups, but this was not statistically significant. Respiratory medications were used by 6 (26%), 30 (59%), and 40 (91%) patients from "at risk" to GS 3-4, respectively. Patients in the "at risk" group had a decrement in health status, significant utilization of healthcare services, and were often receiving medications not consistent with guidelines.