This work was performed to assess whether a pharmaceutical care program improves outcomes and optimizes quality of life in Egyptian patients with bronchial asthma or chronic obstructive pulmonary disease (COPD). Three hundred and fifty adult patients with bronchial asthma or COPD were selected from the out-patient chest clinics, El-Demerdash hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt; from January 2003 to August 2004. Participants were divided into 175 patients for whom the program was implemented and the remaining 175 patients were considered as control; received the hospital usual care. Patients at the out-patient chest clinics were invited to participate in the pharmaceutical care program. The program consisted of scheduled meetings between the pharmacist and patients to assess drug therapy, plan goals, and intervene through counseling and/or consultation with other health professionals. Three primary parameters were measured monthly. First: health-related quality of life (HRQOL). Second: clinical outcomes including change in peak expiratory flow rate (PEFR), physical findings, numbers of visits to clinics' and emergency department (ED) and hospitalization. Third: the costs. Results showed great statistically significant improvements in HRQOL and the clinical outcome for patients in the intervention group; either asthmatics or patients with COPD, compared with control groups. The monthly average costs were statistically significantly higher for the control group in comparison with either asthmatics or patients with COPD in the intervention group. In conclusion: results from this study provide evidence that through providing structured, co-operative, patientoriented pharmaceutical care, pharmacists can help patients with reactive airway disease achieve desired health outcomes, optimize health related quality of life in realistic economic parameters. Recommendation: Pharmaceutical care would have maximum impact if its effect on patients' outcomes could be demonstrated in community pharmacies by well trained pharmacist. Community pharmacies have the capacity to rapidly implement programs system-wide. However, for programs to be integrated into these pharmacies, a rigorous change in pharmacy education in Egypt will be necessary.