Abstract: Objective To understand the first-diagnosis reporting rate of chronic obstructive pulmonary disease (COPD) among adult residents in Changzhou City from 2020 to 2024 and its annual trends, aiming to provide a scientific basis for the prevention and control of COPD and the optimization of healthcare resource allocation in this region. Methods Data on first-diagnosis reported cases of COPD from 2020 to 2024 were collected from the Changzhou Health Data Management Platform, along with resident population data stratified by age group and sex for the corresponding years. Stratified analyses were conducted by diagnosis year, sex, and age group to calculate crude first-diagnosis reporting rate and age-specific first-diagnosis reporting rate. The age-standardized first-diagnosis reporting rate (ASFDRR) was calculated using data from the Seventh National Population Census of China (2020) as the standard population. A log-linear model was employed to estimate the average annual percentage change (AAPC) in ASFDRR, along with its 95%CI and P-value. Results From 2020 to 2024, a total of 12 925 first-diagnosis COPD cases of adult residents were reported in Changzhou City. The overall crude first-diagnosis reporting rate increased from 37.91/100 000 in 2020 to 100.68 1/100 000 in 2024. The overall ASFDRR rose from 116.83/100 000 in 2020 to 274.59/100 000 in 2024, with an AAPC of 26.55% (95% CI: 5.98%-51.11%, P=0.024). Among these, 9 831 new cases were male, with the crude first-diagnosis reporting rate increasing from 57.07/100 000 to 159.29/100 000, and the ASFDRR increasing from 92.54/100 000 to 223.82 / 100 000, with an AAPC of 27.58% (95% CI: 6.21%-53.26%, P=0.024). There were 3 094 new female cases, with the crude first-diagnosis reporting rate rising from 19.53/100 000 to 45.39/100 000, and the ASFDRR increasing from 26.01/100 000 to 55.33/100 000, with an AAPC of 22.90% (95% CI: 5.19%-43.59%, P=0.024). Both crude and age-standardized first-diagnosis reporting rate of COPD for the total population and stratified by sex showed a statistically significant upward trend (all P < 0.05). Age-specific incidence rate increased significantly with age, with the reporting peak primarily concentrated in the 70 to 74 years old age group. Conclusion The age-standardized first-diagnosis reporting rate of COPD in Changzhou City exhibited a statistically significant and rapid increase from 2020 to 2024. Male reporting rates were higher than female rates, and the elderly population constituted the main reporting group. This trend warrants close attention, emphasizing the need to strengthen screening, early intervention, and standardized management for high-risk populations.