BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a complex condition influenced by various lifestyle factors. Dietary patterns, physical activity, and sleep quality play a crucial role in the prevalence and management of COPD. OBJECTIVES: We aimed to evaluate the relationship between dietary patterns, physical activity, and sleep quality with the prevalence of COPD in the PERSIAN Organizational Cohort study at Mashhad University of Medical Sciences (POCM). METHODS: This cohort study utilized data from 12,000 participants in POCM. Dietary intake was assessed using a food frequency questionnaire, physical activity was measured using the International Physical Activity Questionnaire, and sleep quality was evaluated using the Pittsburgh Sleep Quality Index. Spirometry was performed to diagnose and categorize COPD severity. RESULTS: Out of the eligible 4269 participants, 3768 (91 %) were healthy and 373 (9 %) had COPD. Compared to the highest quartile, the second quartiles and third quartiles of the healthy dietary pattern were inversely associated with COPD prevalence, even after adjusting for confounders for the second and third quarters respectively. The second quartile of the fast-food dietary pattern was positively associated with COPD. Older age and poorer sleep quality were also significantly associated with higher COPD prevalence. Physical activity levels did not differ between healthy and COPD individuals. CONCLUSIONS: Findings of this study indicate that healthy diet with more fruits, vegetables, and whole grains was related to reduced incidence of COPD, while the incidence of COPD was related to poor sleep quality. These findings highlight the possible interplay of lifestyle factors and respiratory health.