The study aimed to describe: the epidemiology of self-reported chronic respiratory disease, patterns of respiratory-related health service utilisation and quality of life in the community in Scotland, in relation to rural and urban locations, and to investigate change over time. At baseline compared with urban respondents, rural respondents reported a significantly lower prevalence of any chest illness, asthma, more than two other chronic conditions and eczema/dermatitis. Rural respondents were less likely to report a number of respiratory symptoms. Respiratory-related health service utilisation was significantly lower among respondents from rural rather than urban practices. Rural residency appeared to be associated with better health status among those with COPD and/or emphysema but the results were not adjusted for potential confounding. At follow-up, the cumulative incidence of self-reported chronic respiratory disease and respiratory symptoms was similar among respondents from rural and urban practices. Patterns of respiratory-related health service use were similar to baseline. There was no evidence of significant rural-urban differences in changes in quality of life scores. The Scottish Executive Urban Rural Classification produced similar results to the general practice-based rural-urban definition. The intermethod reliability study found that some conditions tended to be over-reported, especially those likely to be self-diagnosed. Importantly, there did not appear to be any systematic rural-urban difference in the strength of agreement between self-reported information and the medical records. Where there were rural-urban differences in mean FEV1, FVC or PEF values, rural residents had higher (better) values than urban dwellers.