• ICS monotherapy is not recommended • ICS-containing regimens are not recommended as initial maintenance treatment for COPD patients, except in some patients, such as in those with a history and/or findings suggestive of asthma–COPD overlap where it may be a first choice • LABA/ICS may be an alternative to LAMA/LABA therapy in frequent exacerbators with few symptoms, but it is not preferred due to the risk of pneumonia (Group C) • Symptomatic patients with a history of frequent exacerbations (Group D) can be raised to an ICS-containing triple treatment if their symptoms persist or if they have further exacerbations despite optimal bronchodilation

Notes: Data from GOLD. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2017 Report). Global Initiative for Chronic Obstructive Lung Disease, Inc.; 2017.²⁴

Abbreviations: ICS, inhaled corticosteroid; GOLD, Global Initiative for Chronic Obstructive Lung Disease; LABA, long-acting β2-adrenoreceptor agonist; LAMA, long-acting muscarinic receptor antagonist.