Lastly, in the final paragraph, Dr. Sears states that “long-acting β2-agonists have the potential to mask the clinical effects of increasing eosinophilic airway inflammation when the steroid dose is insufficient” and refers to the article by McIvor et al.4 In this study, 13 patients were rapidly withdrawn from inhaled steroids until an asthma exacerbation occurred and, in many of the patients, ICS were removed altogether. We believe that the reduction in exacerbation rates seen in the study by Matz et al3 and MIASMA with the combination of salmeterol and ICS would not be expected to occur without effective control of the underlying disease by both products. Two trials5–6 examining airway inflammation via lung biopsy and BAL have shown no increase in eosinophils with the addition of long-acting β2-agonists to low-dose ICS compared to higher doses of ICS in symptomatic asthma. In addition, improvement in clinical outcomes (ie, lung function, reduction in exacerbations) were seen in both studies. These combined observations,3,5–6 along with MIASMA2 support the view that addition of long-acting β2-agonists to low-dose ICS provide better overall asthma control than higher-dose ICS.