This article summarizes the Dutch experience with prognosis in three groups of patient with chronic obstructive pulmonary disease. (1) 129 patients with severe chronic airflow obstruction (mean FEV1 1,880 ml, range 1,200 to 2,500 ml); (3) 81 patients out of group 2 with decline in FEV1 over time, without oral corticosteroids. It is clear that, at least in the presence of regular therapy, next to cessation of smoking, a higher reversibility of airflow obstruction and lower degree of airway hyperreactivity are important predictors of a slower decline in FEV1. In our opinion these findings point to the urgency for clinicians to change the nihilistic attitude towards patients with CAO, in that both smoking cessation and an early therapy directed at the reversible part of airflow obstruction and airway hyperreactivity may be able to prevent deterioration. Future studies have to show whether long-term, ongoing therapy with corticosteroids may even change the progression and survival in far advanced disease.