Clinical trials in chronic obstructive pulmonary disease (COPD) patients have shown that the long-term use of inhaled corticosteroids (ICS) in COPD patients reduced the number of exacerbations per patient per year and improved health status . Early studies have suggested increased ICS efficacy in patients with low lung function and frequent exacerbations . The efficacy was reinforced when ICS was used in conjunction with long-acting b2-agonists (LABA) . In most countries, health authorities approved ICS/LABA combinations in COPD patients with severe airflow impairment and frequent exacerbations, as also recommended in the Global Initiative for Obstructive Lung Disease (GOLD) 2007 document . However, several surveys found poor adherence to this proposal among primary care physicians and pulmonologists in ‘‘real life’’, ICS being often prescribed at a milder stage of the disease.