Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The World Health Organization (WHO) estimated that COPD is currently the seventh leading cause of death and disability worldwide, but will rise to the fifth position by 2020. The estimated prevalence of COPD worldwide in 2001 was 1013/100,000 population; it was highest in the Western Pacific Region and lowest in Africa. The mortality from COPD followed the same pattern. The prevalence of smoking is slowly decreasing in the industrialised world and rising in developing countries, especially in Asia and Africa. Cigarette consumption per adult has also decreased in the Americas, remained the same in Europe but increased in all other regions, especially the Western Pacific. Indoor air pollution from combustion of biomass/traditional fuels and coal, previous tuberculous infection, outdoor air pollution and childhood respiratory infections are other important risk factors for COPD in developing countries. The rise in morbidity and mortality from COPD will be most dramatic in Asian and African countries over the next two decades, mostly due to progressive increase in the prevalence of smoking. As developing countries can ill afford the added economic burden of COPD and other smoking-related diseases, there is an urgent need for multi-dimensional actions in reducing the main risk factor of cigarette smoking.