Chronic obstructive pulmonary disease (COPD) is a severe chronic respiratory condition characterised by progressive, irreversible airflow limitation. It is common, affecting more than 16 million people in the United States and is the fourth highest cause of death. The worldwide incidence of COPD is increasing and, in parallel, the economic and social burden the disease incurs. The treatment of COPD is symptomatic, with no drugs currently available to halt the relentless progression of airflow obstruction. However, with a better understanding of the pathological features of the airway inflammation and alveolar destruction that characterises COPD, new therapeutic strategies are being developed. This article provides a critical evaluation of current pharmacotherapy in COPD, essentially bronchodilators (anticholinergics, beta 2-adrenoceptor agonists and theophylline) and corticosteroids, and an overview of international recommendations for their use.