Chronic obstructive pulmonary disease (COPD) remains a leading cause of perioperative pulmonary morbidity and mortality. The anesthesiologist must identify these patients and attempt to optimize pulmonary function in the perioperative period. This requires an understanding of pulmonary pharmacology and the physiological changes associated with the administration of general anesthesia. The risk for postoperative complications also must be anticipated to improve outcome. This review discusses changes in lung function related to surgery, assessment of risk for postoperative pulmonary complications, preoperative pulmonary preparation, intraoperative anesthetic management, and optimization of postoperative pulmonary function.