OBJECTIVES: To evaluate the pharmacotherapy of patients with chronic obstructive pulmonary disease (COPD) and its adherence to GOLD (Global initiative for chronic obstructive pulmonary disease) recommendations. METHODS: Prospective, real-life, observational study of COPD pharmacotherapy of 273 patients during 1-year period. Randomly recruited patients were divided into 4 GOLD sub-groups corresponding to severity of exacerbations as follows: GOLD A (n=14), GOLD B (n=91), GOLD C (n=54), and GOLD D (n=114). Adherence was evaluated through two indicators, as is the therapeutic group of prescribed medicines (their presence in the GOLD recommendations) and changes in pharmacotherapy within the observed period. RESULTS: Over 70% of patients were diagnosed in stage corresponding to GOLD C and D when patients are in an advanced disease. Monotherapy (LAMA and LABA) was most commonly prescribed in patients with GOLD A (50% of the patients in the subgroup) that correspond with GOLD recommendations. Therapy with more than one product (LAMA+LABA, LABA+ICS) was prescribed mostly in patients with GOLD A, (29%) followed by patients with GOLD C (15%), GOLD B (14%) and GOLD D (11%). Fixed-dose combinations were mostly prescribed in patients with GOLD D (LAMA+ LABA/ICS, 87%), followed by patients with COPD GOLD  C (LAMA+LABA/ICS, followed by LABA/ICS) (81%) and COPD GOLD B (LABA/ICS, followed by LAMA+LABA/ICS and LAMA/LABA, 73%). Changes in the pharmacotherapy were not made for 74% of the patients with COPD GOLD B, followed by 71% for GOLD A, 68% for GOLD C and 67% for GOLD D.  CONCLUSIONS: Both indicators suggest tendency for combination therapy and relatively high frequency of changes pointing out a decreased level of adherence, especially for patients in severe stages. Higher compliance with the GOLD recommendations is necessary.