OBJECTIVES: Chronic Obstructive Pulmonary Disease (COPD) is a main worldwide cause of morbidity and mortality. COPD elderly patients spend a large amount of money; elderly population is rapidly increasing due to population aging. COPD prevalence in 40 years or older people is 7.8% in Mexico City. However, there is no information about out-out-pocket expenses of COPD patients in Mexico.  Te objective is to estimate direct costs of COPD from patient perspective in a third level hospital in Mexico. METHODS: A pool was developed from august to november of 2013 in a third level hospital. We included outpatients and inpatients that had been already diagnosed and newly diagnosed with COPD. The diagnosis was carried out by a pulmonologist according to GOLD criteria.  We collected information about direct and indirect costs of the patients and the hospital. We estimate median (p25, p75) annual cost of medical consultation, clinical test, travel, gasoline and food from outpatients and stratifying by severity. All cost were transformed in US Dollars of 2103. RESULTS: We interviewed 242 outpatients. According GOLD criteria the patients were classified as: mild (n=18), moderate (n=105), severe (n=80) and very severe (n=39). Median of age was 71.7 years, 141 (58.3%) were men and 133 (54.9%) had social security. Annual total costs for mild, moderate, severe and very severe were $64.5, $99.9, $130.7 and $138.4, respectively. Median costs from mild to very severe were: medical consultation ($23.1, $27.7); Clinical test ($11.6, $48.4); travel ($2.2, $33.8); gasoline ($6.9, $13.9) and food ($0, 18.4). CONCLUSIONS: According to total cost, severity is positively correlated with the amount of out-of-pocket expenses. The main sources of expenses were medical consultations and clinical test.