COPD is a major cause of mortality and morbidity worldwide with an estimated 2.75 million deaths in 2000 (fourth leading cause of death). In addition to the considerable morbidity and mortality associated with COPD, this disease incurs significant healthcare and societal costs. Current COPD guidelines acknowledge that the following can improve COPD mortality: smoking cessation; long-term oxygen therapy; and lung volume reduction surgery in small subsets of COPD patients. To date, no randomized controlled trials have demonstrated an effect of pharmacological treatment on mortality, although several observational studies suggest that both long-acting bronchodilators and inhaled corticosteroids may provide a survival benefit. The possibility that these treatments reduce mortality is being investigated in ongoing large-scale clinical trials.