The deficiencies of current therapies and the potential benefits of novel approaches to chronic obstructive pulmonary disease (COPD) were reviewed at a symposium organized at the National Heart and Lung Institute, London, U.K., July 7-8, 1999. Several speakers discussed different facets of the disease. The keynote lecture dealt with two major, but distinct themes: the utility of computerized tomographic scanning as both a quantitative and a qualitative tool and the recent observation that retinoic acid could produce new alveolar growth, emanating from ducts, in hamsters when it was administered after instillation of elastase. Regarding current therapeutic approaches, bronchodilators are the mainstay of existing therapy, while the use of mucolytics varies markedly between countries. The role of steroids in the treatment of COPD is confused. There is surprisingly little evidence of any clinical benefit from the use of antibiotics. Potential future therapies include M(3)-selective muscarinic antagonists, chemotactic mediators, protease inhibitors and antiinflammatory agents.