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We recommend against treatment with inhaled corticosteroid (ICS) monotherapy in stable COPD patients. Acknowledging the negative impact of acute exacerbations of COPD, reductions in lung function and the potential adverse consequences of therapy, we continue to support the guidance that the clinical phenotype should drive pharmacotherapy for patients with COPD. If therapy was started without a clear indication (such as the use of an ICS in a patient with no history of exacerbations), you may consider initiating a step down. However, if therapy was started according to recommendations and treatment has been effective, a step down is not recommended. De-escalation should only be considered in patients at low risk of morbidity and mortality, and after a period of considerable stability. If you decide to step down, we highly recommend monitoring patients carefully with regular clinical assessments including monitoring of lung function and re-occurrence of exacerbations. We suggest that oral slow-release theophylline should not be used, as it does not prevent acute exacerbations of COPD in patients on optimal long-acting inhaled therapy.