Prognosis in severe chronic obstructive pulmonary disease is poor, and
it is increasingly accepted that such patients need good palliative c
are. This paper reviews the medical management of chronic obstructive
pulmonary disease, and also discusses the place of long-term oxygen th
erapy. A multidisciplinary programme termed 'pulmonary rehabilitation'
is being used increasingly, and, although this probably does not impr
ove survival, there is evidence that it increases quality of life. The
drug treatment of dyspnoea has been disappointing, but close attentio
n to psychosocial aspects can improve mobility and control. The place
of palliation in a number of other chronic lung conditions is also men
tioned.