Chronic obstructive pulmonary disease (COPD) should be strictly differentiated from bronchial asthma--even though, in particular after a lengthy course of illness, mixed forms are also to be seen in the doctor's office. Today, the treatment of choice for bronchial asthma is the use of inhalative glucocorticosteroids which, in the case of COPD, are only of secondary importance. In a poll we conducted, however, 18 out of 28 COPD patients in two pneumological centers in Frankfurt/Main, received a glucocorticoid, although only 20% of these patients may be expected to respond positively to this form of treatment. A step-down-schema permitting an early check of whether a response to glucocorticoid is to be expected in COPD patients is proposed. Independently of this, however, 14-day treatment of acute exacerbations with glucocorticoids improved the results of treatment to a small, but clinically relevant, degree.