Comorbidities significantly contribute to morbidity, mortality, and health care costs in individuals with chronic obstructive pulmonary disease (COPD). Comorbidity prevalence does not always correlate with lung disease severity and the elevated risk of certain comorbidities is often independent of shared risk factors such as tobacco burden. While COPD management guidelines recognize the importance of identifying and treating comorbidities as part of the comprehensive management of COPD patients, little guidance is provided regarding best screening practices. Whereas universal comorbidity screening in COPD patients is likely not cost-effective, targeted early screening and treatment in those at highest risk may have a significant impact on COPD outcomes. Recent studies suggest that certain radiographic features on thoracic imaging may serve as surrogate markers of comorbidity in patients with COPD. This review evaluates these studies in the context of the growing availability of chest CT scans in the lung cancer screening era and discusses how chest CT imaging can be leveraged to identify those COPD patients at highest risk for comorbid disease.