In elderly people the respiratory function is affected by anatomical and physiological modifications caused by aging. Elderly COPD patients are characterized by a complexity due to an increasing prevalence of comorbidities related to the age that suggest peculiar care in prescribing the therapy in those patients, also considering other disabilities that are not related with respiratory disorders as physical and mental limitations. Nowadays a therapy that allows modifying the long-term decline in lung function of patients suffering from COPD does not yet exist and, therefore, the treatment of this disease is mainly focused on the administration of bronchodilators and the use of inhaled glucocorticoids. As for younger subjects, also in elderly patients the main classes of bronchodilators used in the treatment of COPD include β2-agonists, anticholinergics and methylxanthines. The inflammatory response suppression represents another mechanistic approach for treating COPD in the elderly, although the use of inhaled corticosteroids is limited to specific indications. Indeed, nowadays there is a strong medical need for novel treatments of COPD in the elderly. These are mainly represented by agents that reduce the spillover of inflammatory mediators from the lung and by compounds that inhibit the chronic systemic inflammatory syndrome. The therapeutic approach of COPD in elderly patients remains a topic of increasing interest, however the development of novel compounds for preventing the COPD progression in the elderly, other than bronchodilators and corticosteroids, remains a challenge.