OBJECTIVES: To estimate the economic consequences of an ameliorated adherence to GOLD guidelines recommendations for Chronic Obstructive Pulmonary Disease (COPD) management in the Italian clinical practice.  METHODS: A Markov model compares the current approach for COPD treatment (CURRENT strategy) with a strategy of care (GOLD GL strategy) mainly consisting of universal spirometry-based staging, alignment of the pharmacological therapy to guideline recommendations implemented by expert opinion. Drug consumption of the CURRENT strategy is based on data of 3113 patients collected by three Local Health Units. The consumption of other health resources, i.e. medical visits and inpatient care, is estimated from a multicentre observational Italian study, from which also their variation as a consequence of the improved adherence to GOLD is derived. Costs are calculated from the National Health Service perspective, based on published analyses and current prices and tariffs.   RESULTS: The adoption of the GOLD GL strategy for the treatment of the over  1250,000 prevalent Italian COPD patients results in a cost increase of 19 million Euros for the restaging and of 100 million Euros for the redefinition of the clinical management strategy, compared to the CURRENT strategy. Furthermore, the adaptation of the pharmacological therapy to GOLD recommendations, (essentially a higher usage of long-acting beta agonist/corticosteroid combinations), increases  costs by more than 320 million Euros. On the other side, the consumption of other health care resources is reduced by 44%, an estimated cost saving of more than 850 million Euros. The net cost saving associated with the improved GOLD guideline adoption results in 410 million Euros.  CONCLUSIONS: The model estimates that the adoption of GOLD guidelines in the Italian clinical practice is associated to an increase of expenses for pharmaceuticals and diagnostic (or staging) tests, more than offset by cost savings related to lower consumption of other health care resources.