Chronic obstructive pulmonary disease (COPD) has been a public health priority for many years and many recommendations have been published on its detection and management.Chronic obstructive pulmonary disease (COPD) has been a public health priority for many years and many recommendations have been published on its detection and management.Many studies have shown that practice remains sub-optimal, at both diagnostic and therapeutic levels, in the stable state and during exacerbations. There are multiple factors responsible including the recommendations themselves (method of development, format, distribution and implementation) and persisting grey areas in the literature upon which they are based.Chronic obstructive pulmonary disease (COPD) has been a public health priority for many years and many recommendations have been published on its detection and management.Many studies have shown that practice remains sub-optimal, at both diagnostic and therapeutic levels, in the stable state and during exacerbations. There are multiple factors responsible including the recommendations themselves (method of development, format, distribution and implementation) and persisting grey areas in the literature upon which they are based.To improve this situation it will be necessary to clarify the place of various treatment options during the evolution of the disease, to define the best organisational care pathways and to produce precise and didactic guidelines that will be widely distributed and implemented.Chronic obstructive pulmonary disease (COPD) has been a public health priority for many years and many recommendations have been published on its detection and management.Many studies have shown that practice remains sub-optimal, at both diagnostic and therapeutic levels, in the stable state and during exacerbations. There are multiple factors responsible including the recommendations themselves (method of development, format, distribution and implementation) and persisting grey areas in the literature upon which they are based.To improve this situation it will be necessary to clarify the place of various treatment options during the evolution of the disease, to define the best organisational care pathways and to produce precise and didactic guidelines that will be widely distributed and implemented.Real progress can be anticipated in view of the increasing quality of the guidelines and the clinical trials upon which they are based.