OBJECTIVES: To estimate direct and indirect costs and quality of life (QoL) of patients with COPD exacerbation in comparison with costs and QoL of patients with similar COPD severity (GOLD criteria) but without exacerbation. METHODS: A total of 90 in- and outpatients with COPD (grade II – IV) exacerbation (EXA-group) were assessed retrospectively (3 month prior to exacerbation) and prospectively (3 month after exacerbation).  A control (CO-group) of 90 patients with the same grade distribution but in stable health during past 3 months was assessed retrospectively (past 3 months). Direct costs were hospitalization, outpatient visits, laboratory tests, imaging, medication and rehabilitation. Indirect costs included short and long term disability payments. All costs were converted to a period of 180 days; health care costs used 2008 prices from the payer´s perspective. At inclusion day (in both groups) and at final visit in the EXA-group a validated Czech translation of the EQ5D was completed. RESULTS: Both groups were comparable at baseline in terms of age, gender, duration of COPD. Mean 6-months costs were significantly higher, €3796 vs. €1540(1€=26CZK), in the EXA-group (p<0.001). Direct costs accounted for 86 % in the EXA-group and 78 % in the CO-group. Costs for exacerbation management (hospitalization and/or outpatient treatment) and medication represented major cost-drivers in the EXA-group. In the CO-group medication represented 52 % of direct costs. EQ5D utilities in the CO-group and in the EXA-group at final visit were comparable (0.566 EXA-group vs. 0.582 CO-group; NS). EXA-group utilities at inclusion were significantly lower compared to final measurement (0.377 EXA-entry v.s. 0.566 EXA-final; p<0.001), reflecting the quality of life impairment during COPD exacerbation. CONCLUSIONS: The BURDEN study confirmed for the Czech Republic a considerable economic burden of COPD exacerbations. It also showed severe impairment of QoL. Results are in accordance with international literature.