Chronic obstructive pulmonary disease is indeed a multifaceted illness. The obstructive picture is the result of multiple pathologic processes. The most common cause is cigarette smoking. The key to decreasing the incidence of this disease is education to prevent people from starting to smoke and to educate those who do smoke to stop. The therapeutic management involves numerous medications, oxygen, and physiotherapy. Unfortunately, the pharmacologic management remains largely empiric with sympathomimetics, anticholinergics, methylxanthines, and corticosteroids. These agents, especially methylxanthines and corticosteroids, are not without considerable toxicity. Therefore, embarking on a pharmacologic plan requires weighing the risk to benefit ratio carefully and having a comprehensive plan to assess subjectively and objectively the efficacy and toxicity of the chosen therapy.