Long-acting bronchodilators are the mainstay of inhaled therapy in COPD. Both long-acting β-agonists (LABA) and long-acting muscarinic antagonists (LAMA) are effective at reducing breathlessness and exacerbation frequency, with LAMA being the more effective of the two classes . The Global Initiative for Chronic Obstructive Lung Disease advises that inhaled corticosteroids (ICS) are reserved for those who exacerbate more frequently and preferably after the addition of dual long-acting bronchodilators . Some people with COPD benefit from ICS, and there is evidence that blood eosinophil count is a useful biomarker to highlight who might benefit . ICS are known to increase the risk of pneumonia in people with COPD  but despite the guidelines, many people with COPD are prescribed LABA/ICS combinations as initial inhaled therapy . Suissa et al.  reported real-world evidence comparing LABA/ICS with LAMA as the initial treatment of COPD, stratified by blood eosinophil count, detailing both the benefits for exacerbation frequency and risk of pneumonia with each treatment strategy.