Aims & Background: The prevalence of chronic obstructive pulmonary disease (COPD) is very high in India leading to increased morbidity and mortality. Pharmacotherapy for the same has been updated on a regular basis. The current study analyzed adherence to standard guidelines and any impact on healthcare expenditure as well as on survival prediction. Our study aims to evaluate adherence to GOLD 2019 guidelines. Also, analysis of survival prediction by BODE index along with the cost of therapy in COPD patients. Materials and Methods: A Prospective, observational study of 8 weeks was carried out on the patients visiting the Medicine department at a tertiary care teaching hospital who was diagnosed with COPD. COPD-diagnosed patients were recruited as per inclusion criteria. Demographic profile, drug therapy, adherence to the regimen, and direct cost of whole therapy were analyzed. For survival prediction BODE index was used. Data were assessed via IBM SPSS 25.0. Results: As per GOLD grading, out of 36 patient’s majority (69.4%) were found in GOLD 2 which is a moderate category in COPD patients. The majority of patients showed adherence to levosalbutamol and ipratropium bromide (1.25mg, 500mg) drug combination by inhalational route. Considering adherence, 6 patients received treatment as per the new GOLD 2019 guideline whereas 30 patients were discordant. The majority of patients (44.4%) had to spend only about 101-200 INR for the treatment. In survival prediction, BODE 2 scores were found maximum with 23 (63.8%) in numbers. Conclusion: This study evaluated very low adherence to the new GOLD 2019 guideline with the low economic burden on COPD patients treated in the government setup. Also demonstrates the value of BODE index scoring. Efforts are required to improve adherence with the latest recommended guidelines to further reduce morbidity and mortality. Clinical significance: By implementing evidence-based guidelines, healthcare providers can improve patient outcomes, reduce healthcare costs, and improve the overall quality of care for patients with COPD.