Hyperinflation is an important element in chronic obstructive pulmonary disease (COPD), contributing significantly to dyspnoea and exercise intolerance. Bronchodilators have some, albeit slight, effect on hyperinflation. Lung volume reduction surgery has been advocated in a highly select group of patients with heterogeneous, predominantly upper lobe, emphysema but morbidity and mortality associated with this intervention have hampered its widespread use in respiratory medicine. Bronchoscopic lung volume reduction has recently been introduced. Several studies have shown promising results, again in a highly select group of patients, with clinically relevant effects on symptoms, lung function and quality of life. However, for most COPD patients, prevention and slowing down of disease progression are much more important. Smoking cessation is the single most important intervention to achieve these goals. Furthermore, effective new anti-inflammatory drugs are needed since inhaled steroids, although widely used in COPD, are largely ineffective.