In every meta-analysis, a balance must be struck between including as many studies as possible and not oversimplifying the reported data. For example, Atlantis and colleagues1 combine studies that assessed the effect of psychologic factors on both the development (ie, among healthy individuals) and the progression (ie, among patients with COPD) of COPD. Although the combination of these end points provides a strong message that psychiatric factors are important in the context of COPD, aggregating such data tends to diminish the potential clinical utility of the results. For example, in our recent meta-analysis,3 which focused on the progression of the COPD, we found an important distinction between the impact of anxiety vs depression on risk for exacerbations. Our pooled analyses indicated that patients with anxiety were at greater risk for outpatient-treated exacerbations (ie, those treated in the patient’s own environment), whereas those with depression were at higher risk for exacerbations treated in-hospital (ie, in the ED or requiring hospitalization). This distinction may have clinical importance in COPD and on how a respiratory physician may intervene with a patient with depression compared with anxiety. As such, caution is needed when reducing outcomes in COPD. This kind of crude classification is likely to provide an incomplete picture of COPD morbidity in relation to psychologic factors and may be the reason why this meta-analysis provides seemingly exaggerated risk ratios compared with previous reviews.