Uncertainties on whether to use systemic steroids have entered the minds of intensive care and respiratory communities. ...questions regarding which life-sustaining treatments to start, when to start them and even whether to start them are faced by clinicians on a daily basis. Are patients with COPD at an increased risk for COVID-19? Since patients with COPD are vulnerable to viral respiratory tract infections, and COPD is generally a disease of the elderly, many had expected that patients with COPD would have a considerably increased risk of acquiring COVID-19. Since the safety of nebulisers is controversial and given that there is a suitable alternative, we recommend bronchodilators administered by pMDI and spacer over the use of nebuliser treatment in symptomatic patients with COPD and COVID-19. For healthcare workers, respiratory masks (FFP-3 or equivalent) and other personnel protective equipment should be used during aerosol-generating procedures such as nebulisers.15 Systemic corticosteroids It is recognised that not all AECOPDs need to be treated with systemic corticosteroids.5 Eosinophil-based steroid treatment has been advocated for both stable COPD and AECOPD; however, the use of this strategy in patients with COPD and COVID-19 has not been tested. ...recently, the efficacy of corticosteroids in general for treating COVID-19 was inconclusive, though a cohort study suggested steroids might improve clinical outcome in patients with COVID-19.16 Recent, preliminary results from the Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial have shown that dexamethasone improves mortality in patients with COVID-19 requiring respiratory support.17 The WHO recommended against the use of steroids previously,10 but is now updating treatment guidelines to include dexamethasone or other corticosteroids.