OBJECTIVES: Information on the implementation of national (NVL) and international guidelines (GINA and GOLD) for asthma and COPD in German clinical practice is limited. METHODS: Research on inhaled corticosteroid/long-acting β2-agonists (ICS/LABA) in asthma and COPD in Germany was conducted by a modified Delphi Process with a panel of physicians (six GPs and four pulmonologists) to produce 25 consensus statements. RESULTS: Three consensus statements provide insight into current controversies on ICS/LABA use in German clinical practice. Consensus on the statement “Early initiation onto ICS/LABA therapy can improve asthma control and help reduce the rate of exacerbations for patients with persistent asthma who are not sufficiently controlled”, suggests that this is current clinical practice in Germany, consistent with GINA, rather than with the NVL recommendation of doubling the ICS dose. The panel agreed that stepping down LABA in established ICS/LABA therapy, would lead to loss of control and/or worsening of symptoms in around 50% of patients. It was agreed that by early initiation of ICS/LABA in uncontrolled asthma 70–80% of health care resource utilisation could be avoided. Another statement: “A typical patient that should be initiated on ICS/LABA has moderate to severe COPD, suffers from symptoms and experiences exacerbations” suggests that clinical practice among German physicians anticipated the 2011 GOLD guideline, in which initiation of a fixed ICS/LABA combination is based on combined assessment of COPD severity including exacerbation history and the presence of symptoms. The panel estimated that timely initiation of ICS/LABA therapy in COPD patients could prevent 10–40% of unscheduled visits (hospitalisations, emergency room and physician visits). CONCLUSIONS: The results of this research suggest that early initiation of ICS/LABA therapy could substantially reduce unscheduled treatment costs in asthma patients, and that timely introduction of LABA/ICS therapy for COPD patients could substantially reduce both unscheduled treatment and hospitalisation costs.