PT - JOURNAL ARTICLE AU - Pierre Ernst AU - Nathalie Saad AU - Samy Suissa TI - Inhaled corticosteroids in COPD: the clinical evidence AID - 10.1183/09031936.00128914 DP - 2015 Feb 01 TA - European Respiratory Journal PG - 525--537 VI - 45 IP - 2 4099 - http://erj.ersjournals.com/content/45/2/525.short 4100 - http://erj.ersjournals.com/content/45/2/525.full SO - Eur Respir J2015 Feb 01; 45 AB - In this article, we focus on the scientific evidence from randomised trials supporting treatment with inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD), including treatment with combinations of long-acting β-agonist (LABA) bronchodilators and ICS. Our emphasis is on the methodological strengths and limitations that guide the conclusions that may be drawn.The evidence of benefit of ICS and, therefore, of the LABA/ICS combinations in COPD is limited by major methodological problems. From the data reviewed herein, we conclude that there is no survival benefit independent of the effect of long-acting bronchodilation and no effect on FEV1 decline, and that the possible benefit on reducing severe exacerbations is unclear. Our interpretation of the data is that there are substantial adverse effects from the use of ICS in patients with COPD, most notably severe pneumonia resulting in excess deaths.Currently, the most reliable predictor of response to ICS in COPD is the presence of eosinophilic inflammation in the sputum. There is an urgent need for better markers of benefit and risk that can be tested in randomised trials for use in routine specialist practice. Given the overall safety and effectiveness of long-acting bronchodilators in subjects without an asthma component to their COPD, we believe use of such agents without an associated ICS should be favoured.The benefits of ICS in COPD are limited. Better tools are needed to identify which patients might benefit. http://ow.ly/EwuhS