In COPD, evidence supports the use of an inhaled corticosteroid (ICS) in combination with a long acting beta-agonist (LABA) or as part of a triple therapy regimen with the addition of a long acting muscarinicantagonist (LAMA) to reduce the risk of symptomatic exacerbations. The effect of these regimens (ICS/LAMA/LABA and ICS/ LABA vs LABA/LAMA) is greater in patients with high exacerbation risk (≥2 exacerbations and/or 1 hospitalization in the previous year). However, until recently there has been no consistent evidence on the long-term effects of ICS on mortality or the group of patients who would benefit most.