OBJECTIVES: To review the clinical outcomes of patients hospitalized with chronic obstructive pulmonary disease (COPD) acute exacerbations in Singapore and to describe the impact of evidence-based management programs. METHODS: A retrospective review was designed for COPD exacerbations patients admitted from year 2000 to 2005 in three public hospitals in Singapore. Adult patients aged 40 years and above with COPD as the primary reason for hospitalization were retrieved from computerized database. The outcomes studied included average hospital length of stay (LOS), in-hospital mortality rate and readmission rates within 15 days, 30 days and 90 days. Univariate ANOVA and Chi-square test, multivariate regression models and trend analysis were applied to generate statistical results. RESULTS: Among all 2996 COPD patients, 78.8% were male (95% CI: 77.3-80.3%). Chinese were about 82.4% (95% C.I.: 81.0-83.8%), Indian 6.6% (95% CI: 5.7-7.5%), and Malay 7.8% (95% CI: 6.8-8.8%). Patients aged 60 and above were the major population, taking up to 90.4% (95% CI: 89.3-91.5%). From 2000 to 2005 there were significant declines in LOS (6-3 days; p<0.001), and mortality (12.1-3.7%; p<0.001) rates. There were also significant reduction in readmission rates at 90 days (22.5-13.6%; p<0.001) but not at 30 days (11.8-8.6%; p=0.076) or 15 days (6.5-6.0%; p=0.218). By multivariate regression, by controlling other factors, age is a risk factor for longer hospital LOS (p=0.02). Elder patients are also more dangerous on in-hospital death (p<0.001) and readmission within 90 days (p=0.043). All the readmission rates for male patients were significantly higher than females (p=0.002, p<0.001 and p<0.001 for 15, 30 and 90 days respectively). CONCLUSION: In summary, although the study suffers from several limitations, i.e. lack of controls, confounded by disease severity etc, it has shown that implementation of goal directed management programs in COPD patients was associated with positive trends in reduced hospitalization, hospital mortality and readmission rates.