We thank Dr. Oba for his interest in and comments on the revised document of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (1). We acknowledge that there are limits to the evidence base for roflumilast, but find that there is sufficient evidence for improvement in lung function and reduction of exacerbations, as stated in the document. However, as the evidence is weaker than for other drug classes, and because of the less favorable side effect profile, we do not recommend roflumilast as a firstchoice therapy but rather as one of several alternative choices. The GOLD document also lists all the adverse effects of roflumilast mentioned by Dr. Oba. We are somewhat less encouraged by the effects of theophylline than Dr. Oba, but do list theophylline as another possible treatment, and to a broader range of patients. We also thank Dr. West for pointing out the limitations of using FEV1 alone and not considering the underlying pathophysiology leading to chronic bronchitis and/or emphysema—there is a significant proportion of patients with both. However, as we have no treatments aimed specifically at either of these disorders, we do not think a global document gains from “splitting” rather than “lumping” for management. We disagree with the statement that only subjects with reversible airway obstruction (at least measured as FEV1 reversibility) will benefit from bronchodilator treatment, and we therefore recommend a treatment trial with bronchodilators in patients with symptoms. As in medicine in general, this needs to be followed up, and patients who do not feel any benefit should of course not continue for symptomatic purposes alone. We believe that on a global scale, exposures other than smoking matter for the development of persistent airflow limitation, and we do not see any reason to highlight smoking here. And is chronic obstructive pulmonary disease (COPD) treatable? Yes, as treatment includes symptom management; not least, nonpharmacological treatment, such as pulmonary rehabilitation, has a major impact on symptoms and quality of life. Dr. Tzouvelekis and colleagues turn our attention to combined pulmonary fibrosis and emphysema. We also find the topic very interesting but find that our current knowledge on this entity does not warrant specific focus on combined pulmonary fibrosis and emphysema in the executive summary of a global COPD document. We hope that current and future research will enable us to better understand and manage this subgroup of patients with COPD.