: Thousands of railroad maintenance-of-way (MOW) workers develop chronic obstructive pulmonary disease (COPD) from their work.This study calculates the social and economic burdens of COPD borne by thousands of MOW workers.Economic calculations are derived from the literature and also from a survey of 4,800 MOW respondents, 155 in-depth interviews, and two focus groups.COPD alone costs at least $179 million over the course of cases currently diagnosed among MOW workers. Many individuals work through significant pain and breathing difficulties or have to leave the profession. Some are crippled for life.When a worker has COPD, beyond pain and suffering, there are often financial burdens that affect families, railroad companies, insurers, communities, and taxpayers as well as the injured workers.