Patients with chronic airways obstruction have been reported as presenting with psychiatric illnesses commonly. The anxiety and depressive disorders, which are the most common psychiatric illnesses, are known significantly to affect patients' level of occupational and social function. Four cases are presented to illustrate the differing presentations of psychiatric illness in patients with chronic airways obstruction. Conventional psychiatric treatment modalities can be used successfully, in spite of severe airways obstruction, and may lead to a markedly improved quality of life for these patients.