OBJECTIVES: To estimate and compare the use and frequency of medical resources needed in the treatment of exacerbation episodes  in patients with COPD at outpatient and inpatient care levels from a public Mexican institutional perspective, in this case insured patients from the “Instituto Mexicano del Seguro Social” (IMSS). METHODS: From January to December 2013, a retrospective study was performed to estimate the direct medical costs of COPD exacerbations. The level of acuteness and treatment patterns used for the study where the same as those defined by the institution (IMSS guideline). Patient records were retrieved from the open institutional electronic databases for a 11822 COPD patients cohort. Exacerbation episodes were classified according to the guideline. Inpatient and outpatient care was the criteria for assessing the use and frequency of medical resources, including relevant outcomes as hospitalization, physician visits, intensive care unit, surgery, medication use, clinical studies among others. Unitary costs were obtained from public tabulators (2014 IMSS). Mean frequency values were weighted with its corresponding costs.  RESULTS: In 2013, 16122 episodes of exacerbation were reported by the studied subjects. Patients over 45 years represented 97% of all cases; being those over 65 years the most frequent (81%). A mean average of 5.6 days of inpatient care was founded at the study horizon. Yearly weighted cost of treatment for outpatient and inpatient care was US$8,630 and US$51,259 respectively. A unitary item costs analysis from the inpatient versus the outpatient treatment groups founded a significant increase in medication use (+83%), specialty visits (+100%), surgery (+100%) among other items. CONCLUSIONS: In the treatment of exacerbation episodes in patients with COPD, the aggregated cost per year of inpatient versus outpatient care was estimated to be 83% higher. Reducing the risk of exacerbation episodes with the right treatment choice would be relevant for Mexican institutions.