Inhaled corticosteroids (ICs) are used widely in the management of chronic obstructive pulmonary disease (COPD). The large TORCH study found that the IC fluticasone in a dose of 1000 μg was associated with improved quality of life and reduction in COPD exacerbations.1 However, one surprising finding was that pneumonia was more common in the group on fluticasone. A subsequent large nested case-control study showed a 70% increase in admission to hospital with pneumonia in COPD patients taking a variety of ICs.2 The risk was higher with doses above the equivalent of …