OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a degenerative condition with symptoms, disability and impaired quality of life that according to PLATINO study has 15% of prevalence in the population over 40 years-old in Brazil with airflow obstruction who previously diagnosed with chronic bronchitis or emphysema. This study was designed to raise the resource use and economic impact of the exacerbation from COPD under the private healthcare system and the importance of maintenance treatment avoiding exacerbation. METHODS: A modified Delphi panel was conducted with specialist in COPD management to capture the clinical practice and use of resources to non severe and severe exacerbation treatment. Exacerbation reduction from maintenance treatment with tiotropium was taken from literature. Only direct medical costs were taken. For physician fees, procedure reimbursement, inpatient costs and drug costs were gathered from public lists (CBHPM 5th, Kairos, PHROASA) that are the base for negotiations between providers and payers. The Brazilian guideline for economic evaluation was followed to guarantee the methodological robustness (Vianna, 2008). Discounts were not applied for the time horizon of 1 year. RESULTS: For each non severe exacerbations the total cost was R$ 413 (physician fees for emergency, ambulatory care and consults in the hospital was R$ 180, R$ 210 for drugs and R$ 23 for oxygen therapy) and for severe cases total cost was R$ 5,221 per patient (average LOS of 11 and cost of R$ 2,228, physician fees for consults R$ 581, R$ 483 for exams and R$ 2583 for drugs and R$ 228 for oxygen therapy). Considering the incorporation of tiotropium in the maintenance phase, a reduction of up to 25% in the average exacerbation costs compared with the usual care of R$ 1,831. CONCLUSIONS: Tiotropium showed potential to reduce the economical burden of COPD due to exacerbation’s reduction and delay.