Since 2016, chronic obstructive pulmonary disease (COPD) has been the third-leading cause of death worldwide, with an estimated 3 million deaths (5.3% of all deaths), but with large regional variations [1]. Observed data from high-income countries (HICs) [2–5] and modelled data in two global studies [6, 7] have reported declines in COPD mortality rates since the 1990s. Globally, since 2006, modelled COPD mortality rates decreased by 21% [8]. Yet, little is known about observed trends in COPD mortality in Latin America, and more recently in Oceania and Europe. Mortality data can be expressed in many ways, for different purposes. Absolute death counts are useful to clinicians and for local use; crude mortality rates allow comparisons with other conditions, and regional healthcare planning. Finally, standardised mortality rates are valuable for comparison between countries and/or period by adjusting for differences in the demographic composition. For our study, COPD death counts were extracted from the World Health Organization (WHO) mortality database [9] between 1995 and 2017, using International Classification of Disease-10 codes of chronic bronchitis ( J40–J42), emphysema ( J43) and other COPD ( J44) [5]. No redistribution of ill-defined codes was performed. Countries with ⩾2 million inhabitants in 2010 and vital statistics covering >90% of their national population, a proportion of ill-defined causes of death 10 continuous years by sex and <5% of unknown age at COPD death were selected. Corresponding population data were obtained from the United Nations population 2017 revision estimates [10].

Since its inception in 2002, World COPD Day is celebrated to raise awareness and reduce COPD-related burden. In spite of this global effort, COPD remains poorly recognised. Indeed, BOEHM et al. [1], using Google Trends, noted the rather limited global awareness of COPD, which rates eighth within the top 10 causes of disease burden searched. On a positive note, they identified a seasonal trend, with a peak activity in November, that could be related to the increased incidence of acute exacerbations during the winter period, but it may also reflect the “noise” created by initiatives like the COPD Awareness Month and World COPD Day. The 2019 theme for World COPD Day is “All Together to End COPD”. Optimistically, recent evidence of projected global COPD mortality rates indicates this theme to actually be more than wishful thinking.

At age 50 years, Charles Darwin (figure 1) published his theory of evolution, On the Origin of Species, in full, for his fellow scientists and for the public at large [1]. It was exactly 160 years ago, on a Thursday, 24 November 1859, priced at fifteen shillings. Three recent reports in the European Respiratory Journal on chronic obstructive pulmonary disease (COPD) have reminded us that not only species, but also diseases, experience evolution. At first glance, the three papers appear unconnected. In this issue of the European Respiratory Journal, BOEHM et al. [2], describe the global awareness of COPD based on results from a popular internet search tool, Google Trends, that has proved of medical use in identifying and tracking epidemics in communicable and non-communicable diseases [3, 4]; within the 10 top causes of disease burden searched, it is no surprise that COPD ranked poorly, eighth according to the metrics they used, highlighting the low profile and the lack of awareness of COPD in the general population, in comparison to other deadly diseases. Of interest, they described a seasonal trend with a peak activity in November, likely related to the increased incidence of acute exacerbations during the winter period, but also reflecting the “noise” created by initiatives like the COPD Awareness Month and World COPD Day. This is good news.

In a recent article, SUISSA [1] proposes several alternative hypotheses to explain the paradoxical effect of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) patients, whereby these drugs can increase the risk of pneumonia and simultaneously reduce pneumonia mortality. In our opinion, the conclusion of the article, that pneumonia mortality is increased in COPD patients treated with ICS, both in observational and in randomised clinical trials (RCTs), is not supported by data and cannot be considered confirmed. Basically, the author maintains that this paradox can be explained by the small number of events in randomised clinical trials (RCTs) and selection bias in observational studies [1].

Not long ago, chronic obstructive pulmonary disease (COPD) was considered a Cinderella, an unappealing disease lacking therapeutic options. It was also stigmatised as a consequence of the smoking habit that is a leading cause of COPD worldwide [1]. However, as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) [2], and the joint American Thoracic Society/European Respiratory Society consensus documents suggest [3], COPD should be viewed as treatable and preventable, offering multiple opportunities for disease modification. Inhalers developed for the treatment of asthma were tested empirically in COPD, long before a mechanistic rationale justified their use. Airway delivery was a common sense solution for a disease characterised by airway inflammation and bronchospasm. Inhaled corticosteroids (ICS) were an obvious therapeutic choice, especially in combination with long-acting bronchodilators (long-acting β-agonists (LABA)). Despite the growing evidence in favour of this strategy as a cornerstone of COPD treatment, the role of ICS continues to be controversial in current clinical practice.