While the metaanalysis by Rodrigo et al11 showed, relative to placebo, no adverse effect of LABA on mortality in COPD, caution must be taken in applying this finding to the real world. In COPD trials, patients are carefully selected and monitored, and asthma is generally excluded. In real life, asthma and COPD can be hard to disentangle especially in older patients, as some asthmatics are also current or ex-smokers. Hence, accepting the metaanalysis showing that LABA monotherapy is appropriate and safe in patients with COPD may put some patients who in fact have asthma at risk if treated in this manner. Given the reduced mortality with the use of ICS in combination with LABA, compared with LABA alone, one would argue that, in COPD as in asthma, concomitant ICS therapy is preferable to LABA monotherapy.