Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition that represents a significant economic burden to society. Early diagnosis of COPD offers the best opportunity to slow the progression of the disease through smoking cessation. Aggressive medical management of COPD for patients diagnosed at a moderate or severe stage is likely to be attractive from an economic standpoint, although prospective studies are needed to validate current evidence. Poor adherence to smoking cessation and pharmacologic therapy suggests that patient education is critical to successful intervention at all stages of illness. The economic value of aggressive pharmacotherapy for early-stage COPD is less certain, but the burden of illness and potential pharmacoeconomic benefits in such patients is a strong rationale for combined clinical and economic trials.