Numerous extensive, randomized clinical trials of beta-blockers have shown significant reduction of total mortality in patients with myocardial infarction and chronic heart failure. The life-saving therapy of myocardial infarction or chronic heart failure with beta-blockers, however, is often withheld from patients with COPD/asthma. Several studies demonstrate that especially patients with COPD would benefit from such a therapy due to their high cardiovascular risk profile. Recent meta-analyses show that cardioselective beta-blockers are well tolerated by these patients without causing relevant limitations in lung function. Present findings suggest that the mortality reduction of beta-blocker therapy may outweigh the risks in patients with COPD and possibly even in patients with mild asthma. Contraindications for beta-blockers include acute exacerbations and severe forms of COPD as well as moderate to severe asthma and the regular use of beta(2)-sympathomimetics. beta-Blocker therapy should be given with low initial doses on an individual basis after careful consideration of the benefit to risk ratio, preferably using cardioselective substances with proven mortality benefits for myocardial infarction and chronic heart failure.