BACKGROUND Once viewed as an irreversible condition, chronic obstructive pulmonary disease (COPD) is now considered as a preventable and treatable disease. The past ten years of research have clearly indicate that dyspnea, exercise tolerance and quality of life can be improved considerably with appropriate therapeutic interventions that include pharmacological and non-pharmacological components. It is also becoming evident that it is the concomitant use of appropriate pharmacotherapy and non-pharmacological approaches, such as exercise training and pulmonary rehabilitation, that offers the best hope for an optimal status. PURPOSE The objective of this short paper is to review the rationale of combining pharmacological and non-pharmacological therapeutic approaches to optimize functional status and quality of life in patients with COPD. PRINCIPAL FINDINGS Optimal bronchodilation is the mainstay of treatment. Leg fatigue will prevent patients with COPD from obtaining full advantage of bronchodilation. Quadriceps fatigue during cycling exercise is linked to events taking place within the muscle providing a muscular and metabolic basis to explain the observation that some patients with COPD develop contractile fatigue after exercise. Muscle fatigue can be improved with exercise training. Pharmacotherapy and exercise training offer the best hope for an optimal status in COPD. CONCLUSION Our goals are to stimulate interest in COPD, provide a strong case against the nihilistic approach to this disease to ultimately raise the standard of care to the benefit of the numerous patients afflicted by this condition.