Chronic obstructive pulmonary disease (COPD) has multiple pathophysiologic effects that are not confined to the lungs. Similarly, treatment for COPD may have a number of different beneficial effects, and although each of these may be small, their cumulative effect may add up to a worthwhile overall outcome. Many of the effects of COPD are only weakly related to FEV(1), and there is good evidence that health status questionnaires are the best overall measures of disease severity. Recently it has been shown, using such instruments, that health status in patients with COPD deteriorates progressively and at a measurable rate. Fluticasone reduces that decline, an effect that may take months to be detectable but continues to develop over 3 years. The effect of fluticasone on health appears to be due to a reduction in exacerbations coupled with its small effect on FEV(1).