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Objectives: To conduct a systematic review and meta-analysis regarding the efficacy and safety of inhaled corticosteroids for COPD exacerbations. Design: MEDLINE, EMBASE, CINAHL, PsycINFO, and OVID for all English language studies, and Cochrane Central Register of Controlled Trials (CENTRAL) for studies involving corticosteroids for COPD. Main Outcome Measures: We sought to evaluate the efficacy and safety of inhaled corticosteroids for patients with COPD exacerbations for at least 50 days. Results: Studies were identified in 7 medical centers that met the inclusion criteria; 14 studies of inhaled corticosteroids were included. The overall OR for the first dose of corticosteroids vs saline was 2·8 for a 50% reduction [95% CI (1·1–8·8]). The number needed to treat for a 50% reduction for corticosteroids is 5 (interquartile range, 1–17) to achieve a reduction in the mean of 6·2 (range, 3·7–10·8). For a 100% reduction in patients with a COPD exacerbation, the ORs were 4·4 (1·4–8·7), 3·0 (1·1–6·3), 1·7 (1·0–3·9), and 2·5 (1·1–4·7), respectively.[7,30] The majority of patients are able to tolerate inhaled corticosteroids.[6,31] We did not find differences in side effects, dose, or dosing regimens when compared with saline. Most published studies suggest a reduction in cough episodes in patients treated with inhaled corticosteroids, however, the available data on this issue are not complete. The side effects of inhaled corticosteroids are dose-dependent, with dose changes reported to occur more frequently in higher dose groups. Patients treated with inhaled corticosteroids were less likely to develop COPD worsening at the end of the study period and longer-term adverse effects were also less frequent in these groups than compared to those treated with placebo in many studies. For asthma in patients with COPD, the risk of becoming symptomatic during the first 12 months after baseline was reduced by approximately 25% in patients treated with inhaled corticosteroids. Additionally, no significant difference in bronchial asthma developed as a result of these studies compared to placebo.  The majority of current trials involved in a meta-analysis concluded that lung function, respiratory tract infection, and acute Related Article: