We thank L. Mascitelli and colleagues for their interesting comments about the role of the renin–angiotensin system in severe chronic obstructive pulmonary disease. Our review 1 was intended to provide guidance on current established therapies rather than consider potential future treatment options and hence we did not include a comment relevant to this interesting but, as yet, unproven treatment approach. The only data we are aware of that directly addresses this were published recently in the European Respiratory Journal and did not find improvements in pre-specified outcomes after blockade of the renin–angiotensin system 2. This does not preclude a role for this system in some settings in chronic obstructive pulmonary disease; however, it did make us cautious about commenting specifically on the role of these drugs in a review of current disease management.
Statement of interest
None declared.
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