Chronic obstructive pulmonary disease (COPD) is a common cause of disability and a leading cause of admissions to hospital because of exacerbations of the condition. Early intervention with antibiotics and steroids can prevent admissions, but it can be difficult for patients to recognize the early signs of exacerbation and to access timely clinical care. One solution to these barriers to early management is the use of telemonitoring of symptoms and physiological signs. Patients regularly record these and they are made available to clinicians, by the Internet, who based on scoring algorithms are alerted and may then be able to detect early signs of deterioration and intervene. However, the evidence to date for the effectiveness and cost-effectiveness of this approach has not been strong. While early research shows promise, most interventions have been complex and involved additional clinical support rendering interpretation of the impact of telemonitoring alone difficult. The results of larger well-designed trials are awaited. Key to the success of future telemonitoring interventions will be establishment of the utility of different physiological measures and the construction of accurate predictive algorithms which can take into account individuals' risk factors, patterns of symptom and physiological parameters and recent therapy changes.