Many of us wouldn’t dream of not using steroids for a significant COPD exacerbation. We put it on the same level as not giving antibiotics for pneumonia or not giving aspirin for a patient having a heart attack. Despite this deeply engrained belief, the data behind steroid use for COPD exacerbations is shockingly small. I suspect most of you would be surprised to know that I was a second year medical student when steroids were really shown to be beneficial for COPD exacerbations (and no, I wasn’t a second year medical student in the 1980’s)1,2 . With this lack of data, there are many questions that have not been answered about steroid use for COPD exacerbations. Much of what we do, or actually ignore as you will see, is based upon consensus statements or small studies. The evidence for steroid use received a small boost in last months JAMA, although not as big of a boost as many of us would hope. In this blog I will review the evidence for steroid use, including the recent article. So read on as we look at a topic that should have overwhelming evidence, yet doesn’t!