The past 10 years have seen major changes in the way we look at COPD and how we manage this disease. At present, we still have yet to find a therapy that changes the prognosis or reverses disease progression [1], with smoking cessation being the only effective intervention to achieve this. Bronchodilators are currently the main treatment used for the relief of breathlessness in COPD but they do not directly affect the underlying disease process, even though they are effective at reducing exacerbation rates. Long-acting bronchodilators are the preferred therapy, including the anticholinergic (anti-muscarinic) tiotropium bromide and LABAs (salmeterol and formoterol).