Purpose: While early detection and prediction of chronic obstructive pulmonary disease (COPD) is important to improve prognosis and outcomes of COPD, no serologic marker has been identified to predict COPD development. Alanine aminotransferase (ALT) can reflect skeletal muscle volume, and indirectly reflect general performance scale which are significantly associated with COPD development and prognosis. We aimed to define the ability of ALT levels to predict COPD development using a population-based cohort database. Method: We used the health check-up cohort database of the Korean National Health Interview Survey from 2002 to 2003 after excluding subjects with COPD or liver disease, and assessed COPD development for 13 years according to ALT levels at baseline (group 1, ALT [IU/L] <10; group 2, 10≤ALT<20; group 3, 20≤ALT<30; group 4, 30≤ALT<40; group 5, ALT≥40). Result: Among 422,452 subjects, group 1 subjects were predominantly female and never or ex-smoker, compared to group 5 subjects. In males and current smokers, COPD development was most prevalent in group 1, and prevalence decreased as group number increased (males: 4.2%, 4.2%, 3.9%, 3.5%, and 2.9%, respectively, P<0.0001; current smokers: 5.4%, 5.0%, 4.5%, 3.9%, and 3.3%, respectively, P<0.0001). In Cox regression analysis for male subjects or current smokers, group 5 was more preventative in COPD development compared to group 1 (HR, 0.807, P=0.0384; HR, 0.741, P=0.0181). However, the ability of ALT levels to predict COPD development was weak in females, and never and ex-smokers. Conclusion: Males and smokers who present with low ALT levels should be carefully monitored for COPD development.