Chronic obstructive pulmonary disease (COPD) is a major public health problem and its impact is increasing. Only smoking cessation and oxygen for hypoxaemic patients have been shown to alter mortality, but modern pharmacological therapies can improve symptoms, lung function and quality of life. Treatment guidelines emphasise the use of bronchodilators as first-line treatment for COPD but make few recommendations about choosing a specific agent. In this review, the results of recent studies are examined to provide evidence-based guidance for the selection of appropriate maintenance therapy. Guidelines also support the use of inhaled corticosteroids in patients with more advanced disease, and the role of these agents is discussed. © 2005 Ashley Publications Ltd.