OBJECTIVES: Chronic Obstructive Pulmonary Disease (COPD) is a highly prevalent chronic inflammatory disease. Some COPD patients show a co-diagnosis of asthma (COPD-A). This real-life observational study assessed the frequency of exacerbations, the use of healthcare resources and their associated costs in patients with COPD only and COPD-A. METHODS: Medical records from 6 Primary Care (PC) and one general hospital were reviewed and data from 2011 were collected from COPD and COPD-A patients aged 40 year or older who met specific inclusion/exclusion criteria. Main study variables were demography, co-morbidities, exacerbations and resources utilization. RESULTS: 1210 COPD and 102 COPD-A, mean age (% male) 71.8 (85.5) and 71.2 (65.7) years, respectively, were included. Mean co-morbidity burden was similar in both groups with 7.9 and 7.8 diseases per patient. Most frequent co-morbidities (% in COPD; % in COPD-A) were dyslipidemia (63.0; 60.8) and arterial hypertension (59.5; 62.7) whereas the proportion of exacerbations (%) were 35.0 and 42.2, respectively. Mean number of exacerbations per patient per year was 1.2 in COPD and 1.6 in COPD-A. The frequency of severe exacerbations (%) requiring hospitalizations was 0.4 and 0.7, while those requiring oral corticosteroids was 24.4 and 33.0, respectively. Mean per patient, per year healthcare resources costs (Euro) were 2152.2 and 2207.5 for PC-associated costs, and 1361.6 and 1754.3 for specialist care-associated costs, respectively. CONCLUSIONS: Exacerbations are frequent complications in COPD and COPD-A patients. Both groups show high proportion of co-morbidities and use of healthcare resources which were higher in the COPD-A group. Healthcare-related costs are high and are mainly related to hospitalizations and drug therapy.