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Randomised controlled trial
Discontinuing inhaled steroids might not be safe in severe COPD cases
  1. Rafael Laniado-Laborín
  1. Facultad de Medicina, Universidad Autonoma de Baja California, Tijuana, Baja California, Mexico
  1. Correspondence to : Dr Rafael Laniado-Laborín, Universidad Autonoma de Baja California—Facultad de Medicina, Tijuana, Baja California 22000, Mexico; rlaniado{at}

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Recommended treatment for chronic obstructive pulmonary disease (COPD) in patients with frequent exacerbations include a combination of a long-acting bronchodilator (LAB) and inhaled corticosteroids (ICS). The extra benefit on exacerbation rate of adding ICS to a dual LAB regimen has never been determined in an adequately powered trial. The authors conducted a randomised, double-blind, clinical trial to test their hypothesis that ICS could be withdrawn without increasing the frequency of exacerbations in COPD, as long as the patients were still treated with a combination of LAB (tiotropium and salmeterol).


This 1-year, non-inferiority trial included 2485 patients, 40 years or older with severe …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.