Chronic obstructive pulmonary disease (COPD) is expected to become the third cause of death due to continued exposure to risk factors for COPD such as cigarette smoke, to the reduction in all cause mortality and to an ageing world population. The ageing of airways and of lungs lead to structural alterations that are similar to those observed in COPD, for instance the progressive reduction in the thorax wall compliance, the reduction in respiratory muscle strength and the anatomical changes of pulmonary parenchyma and peripheral airways that in the end lead to lung hyperinflation. All these different aspects cause relevant symptoms that have a critical impact on patient’s quality of life related to the health status. In this context the pharmacological treatment choice has to take into account the effectiveness in symptoms control during the most critical part of the day, such as in the morning, the capability to reduce lung hyperinflation, breaking down a vicious circle that starting form dyspnoea lead to muscle deconditioning and to an augment in exacerbation rates, with a worse prognosis. Among the new bronchodilators, aclidinium owing to its pharmacological properties and the well documented efficacy and safety profile.