Purpose: Hospitalization brings considerable economic pressure on chronic obstructive pulmonary disease (COPD) patients in China. A clear understanding of hospitalization costs for patients with COPD is warranted to improve treatment strategies and to contain cost. Currently, investigation on factors contributing to the hospitalization costs for patients with COPD in China is limited. This study aimed to measure the hospitalization costs of COPD and to determine the contributing factors. Patients and methods: Medical record data from the First Affiliated Hospital of Guangzhou Medical University from January 2016 to December 2016 was used for a retrospective analysis. Patients who were hospitalized with a diagnosis of COPD were included. Patient characteristics, medical treatment and hospitalization costs were analyzed by descriptive statistics and multivariable regression. Results: Among the 1,943 patients included in this study, 87.85% patients were male; the mean (standard deviation [SD]) age was 71.15 (9.79) years; 94.49% patient had comorbidities; and 82.30% patients had health insurance. Regarding medical treatment, the mean (SD) length of stay was 9.38 (7.65) days; 11.12% received surgery; 87.91% patients used antibiotics; and 4.53% received emergency treatment. For hospitalization costs, the mean (SD) of the total costs per COPD patient per admission was 24,372.75 (44,173.87) CNY [3,669.33 (6,650.38) USD], in which western medicine fee was the biggest contributor (45.53%) followed by diagnosis fee (27.00%) and comprehensive medical fee (12.04%). Regression found that reimbursement (-0.032; 95% confidence interval [CI] -0.046 to 0.007), length of stay (0.738; 95% CI 0.832 to 0.892), comorbidity (0.044; 95% CI 0.029 to 0.093), surgery (0.145; 95% CI 0.120 to 0.170), antibiotic use (0.086; 95% CI 0.060 to 0.107), and emergency treatment (0.121; 95% CI 0.147 to 0.219) were significantly (p < 0.01) associated with total hospitalization costs. Conclusion: To contain the hospitalization costs for COPD patients in China, the significance of comorbidity, length of stay, antibiotic use, surgery and emergency treatment suggests the importance of controlling the COPD progression and following clinical guidelines for inpatients. Interventions such as examination of pulmonary function for early detection, quality control of medical treatment and patient education warrant further investigation.