Smoking cessation is the most effective intervention to prevent the annual decline in lung function in patients with chronic obstructive pulmonary disease. All primary healthcare providers should routinely ask all patients whether tobacco use is active or not, and advise tobacco users to stop smoking. In Japan a treatment of nicotine addiction with varenicline or nicotine patch has been started under health insurance coverage since 2006. About half of the patients taking varenicline could stop smoking. Education on the health risks of smoking in schools for younger ages is essential for prevention of COPD.