Chronic Obstructive Pulmonary Disease (COPD) is a primary cause of disability and death in the elderly. Its prevalence is dramatically rising, mainly among females, but reliable figures are not available because many elderly, mostly the ones plagued with disability and multimorbidity, cannot perform a good quality spirometry, a sine qua non diagnostic tool. Furthermore, atypical presentations contribute to conceal COPD. Even in patients who received a standardized diagnosis of COPD the GOLD recommended staging criteria are questionable because of some imbalance between classificatory and prognostic properties. The great variety of symptoms applies to both stable and exacerbated COPD. Thus, to diagnose an exacerbation timely may be difficult if the individual pattern of symptoms has not been previously recognized. Accordingly, a truly comprehensive assessment is mandatory to clarify the unique clinical pattern of a given patient and, then, to tailor the multidimensional therapeutic strategy. Such an approach largely depends upon the specialty of the physician in care. Thus, efforts are needed to make all the specialists caring for the elderly respiratory patients share the cultural and procedural patrimony allowing recognize and optimally care these “difficult” patients.