BACKGROUND: Of all the major diseases, chronic obstructive pulmonary disease (COPD) is the one for which the burden is increasing the fastest. OBJECTIVE: This article discusses the diagnoses and assessment of COPD, and provides management guidelines including smoking cessation, bronchodilator therapy, the use of inhaled corticosteroids, combination therapies, oxygen therapy, and rehabilitation. DISCUSSION: Diagnosis is by clinical suspicion in patients with an appropriate clinical history and airflow obstruction is confirmed using spirometry. Although smoking cessation and oxygen in selected individuals are the only interventions known to alter the natural history of COPD, many other treatments can significantly lessen breathlessness, reduce exacerbations, and improve exercise and quality of life. (author abstract)