There is general agreement that chronic obstructive pulmonary disease (COPD) is a global epidemic affecting both developed and, particularly, developing countries. Despite access to the most up-to-date medicine currently available, we all also agree that its management is inadequate in at least two ways; people still smoke cigarettes and, for those who already have COPD, current treatment is inadequate. Patients still suffer and die of COPD. None of our therapies have substantially decreased its mortality or progression in this disease. Similarly, a large proportion of the population world-round suffers from asthma, causing much symptomatology and substantial time lost from school or work as well as mortality. Although effective therapies are available for asthma, the disease in many patients is not adequately controlled. The asthma–COPD overlap syndrome combines the suffering and mortality of both disorders and may require combined therapy. In this Perspective we focus on the drugs currently being developed to address these unmet needs. In fact, the same drug classes are often in development for severe asthma and COPD in parallel, as there are many shared mechanisms of chronic inflammation. In asthma, the greatest need, apart from improving adherence, is the need for therapies that address patients who have severe disease despite using current therapies. In COPD the greatest needs are for treatments that address smoking cessation and the underlying progressive disease process that can continue to damage the airways and parenchyma long after smoking cessation (1).