OBJECTIVES: Chronic  Obstruction  Pulmonary  Disease (COPD)  is  one  of  the  world causes  of   morbidity and  mortality. Level  of  COPD  seriousness  results  in  the  increasing   number  of  Length Of Stay(LOS)  in  the hospital. This research has been conducted in 2014 to analyse total  direct  cost  and cost  effectiveness analysis by  the combination of ipratropium and salbutamol and  single salbutamol on the  COPD  in  Fatmawati  Public  Hospital  Jakarta.  METHODS: COPD patients who were hospitalized in Fatmawati  Public  Hospital  between 1 January 2010 – 31 March  2014  were grouped according to  the  classification  of  COPD by Indonesian Pulmonary Doctor Association. Study design used was cross sectionaland retrospective. In addition, data were analyzed descriptively and calculating the  Pearson correlation (r) that  was   conducted  on   the  seriousness  level  of   COPD  on  total direct  cost. In addition, cost effectiveness of the combination of ipratropium and salbutamol therapy was compared to single salbutamol therapy on COPD patients. RESULTS: Among 237 patients of COPD, 122 patients with primary diagnosis and 115 patients with accompanying diagnosis. There were 97 patients who met inclusion criteria. The average total direct costs were IDR15,069,927.23. The highest  cost  was  on cost of hospital stay, IDR5,106,409.99 (35,32%), followed by medicament cost IDR4,984,922.86 (32,51%).  There  was  a  very  strong   correlation   (r = 0.876)  between  COPD  seriousness  level   with   the   average   direct   total  costs   per  year  with   or   without comorbidity. COPD  therapy, It has also shown,  that cost  and  effectiveness  were  not  significantly  differed   (p > 0.05) between salbutamol combination and single  salbutamol. CONCLUSIONS: In primary care, disease management should more focused on the holistic assessment and reduction of symptoms. For the future purposes treatment of COPD  should follow the published guidelines for systematic diagnosis of symptoms and health status. This is important to improve the clinical outcome of individual and patients.