Inhaled steroids in COPD: when should they be used?

Because chronic obstructive pulmonary disease (COPD) is defined as an inflammatory disease,1 anti-inflammatory therapy for these patients makes sense. Inhaled corticosteroids are well established anti-inflammatory drugs in asthma2 but their positioning in COPD is controversial.3 There is consensus that inhaled corticosteroids in combination with long-acting bronchodilators are indicated in patients with COPD at risk of exacerbation and in those with the asthma–COPD overlap syndrome, but never as standalone therapy.