Depression and anxiety are highly prevalent in elderly COPD patients. Since symptoms of depression and anxiety reduce quality of life in these patients, treatments aimed at improving mental health may improve their quality of life. This study evaluated the effectiveness of a nurse-led Minimal Psychological Intervention (MPI) in reducing depression and anxiety, and improving disease-specific quality of life in elderly COPD patients. In a randomized controlled trial an MPI was compared with usual care in COPD patients. COPD patients aged 60 years or over, and with minor or mild to moderate major depression were recruited in primary care (n = 187). The intervention was based on principles of cognitive behavioural therapy (CBT) and self-management. Outcomes were symptoms of depression, symptoms of anxiety, and disease-specific quality of life, assessed at baseline and at one week and three and nine months after the intervention. Results showed that patients receiving the MPI had significantly fewer depressive symptoms (mean BDI difference 2.92, p = 0.04) and fewer symptoms of anxiety (mean SCL difference 3.69, p = 0.003) at nine months than patients receiving usual care. Further, mean SGRQ scores were significantly more favourable in the intervention group than in the control group after nine months (mean SGRQ difference 7.94, p = 0.004). To conclude, our nurse-led MPI reduced symptoms of depression and anxiety and improved disease-specific quality of life in elderly COPD patients. The MPI appears to be a valuable addition to existing disease-management programmes for COPD patients.