Review Reports

Round 1

Reviewer 1 Report

The authors have made an interesting study on Lack of Association between Inhaled Corticosteroid Use and the Risk of Future Exacerbation in Patients with GOLD Group A Chronic Obstructive Pulmonary Disease. The manuscript can be published; however, the authors need to justify the scientific writing manuscript. Some of the general comments are provided below:
1. It is very interesting study, as some other studies with mild-to-very-severe COPD and predominantly low exacerbation risk showed no differences in mortality with LAMA/LABA versus LAMA/LABA/ICS, suggesting that the survival benefit of triple therapy seen in some recent studies may be specific to a high-risk population. This supports the current Global Initiative for Chronic Obstructive Lung Disease recommendations that triple therapy should be reserved for the subpopulations of patients who need it to avoid ICS overuse. How would the authors comment on those results in comparison to their study?

2. Authors should compare their studies with some recent studies using ICS or combination therapy in the discussion.
3. They have a low number of participants in this study.
4. More references from the last five years should be added.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Despite the fact that this is a retrospective study and that the C group is very few patients, it is well designed to reach a conclusion that is supported by other work: the limited usefulness of inhaled corticosteroids in phenotype A COPD. It has important limitations, which the authors point out at the end of the paper, but even so, its information is useful for clinical practice.

Author Response

We thank the reviewer.