Chronic obstructive pulmonary disease (COPD) is a leading cause of death nationally and worldwide. Cigarette smoking is the most common risk factor in the development of COPD. Disease course is variable with some patients having a high degree of obstruction and minimal symptoms, whereas others with better lung function have a greater symptoms burden. The goal of pharmacologic therapy is to minimize symptoms, improve exercise tolerance, and reduce exacerbation risk. No pharmacologic therapy has been shown to improve survival in COPD. Pulmonology referral is recommended for patients with COPD with symptoms despite first-line inhaled therapy, frequent exacerbations, any hospitalizations, or moderate-to-severe disease.