Weaning from inhaled corticosteroids in COPD: the evidence.

The use of inhaled corticosteroids (ICS) in the treatment of chronic obstructive pulmonary disease (COPD) has been widely debated [1–3]. Treatment guidelines have suggested that their prescription be limited to COPD patients with severe airflow limitation at high risk of exacerbations, who remain symptomatic after regular use of one or two long-acting bronchodilators [4]. Nevertheless, ICS have been used widely, with recent trials observing that over 70% of COPD patients were treated with ICS at the time of enrolment. Evidence is mounting that such extensive use of ICS is discrepant with COPD treatment guidelines and may be inappropriate in a subset of these users [5, 6].