Smoking cessation helps patients with COPD more than any specific medical treatment. By commencing treatment early, the main symptoms of COPD, i.e. cough, dyspnoea, and excessive mucus production, can be relieved and premature mortality from respiratory failure can, in many cases, be prevented. An anticholinergic aerosol offers the greatest bronchodilator benefit with the least side-effects to a patient with COPD. After maximising the dosage of an anticholinergic agent, either an inhaled beta2-agonist or oral theophylline may be added for additional bronchodilator effects. Corticosteroids may be beneficial in a subset of the patients. Selected patients with exercise limitation despite optimal medical therapy may gain from an increased sense of well-being enrolled in a supervised exercise rehabilitation progromrne. Long-term domiciliary oxygen therapy improves survival for patients who are chronically hypoxaemic. Antibiotics are reserved for acute exacerbations. The role of alpha-1-antitrypsin replacement and lung transplantation is still investigational.