Triple therapy comprising an inhaled corticosteroid (ICS), a long-acting β₂-agonist (LABA), and a long-acting muscarinic antagonist (LAMA) has become an important treatment option for chronic obstructive pulmonary disease (COPD). Major randomized controlled trials have demonstrated reductions in exacerbations, improvements in lung function, and better health-related quality of life in selected patients. However, uncertainty remains regarding whether triple therapy should be prescribed universally as first-line treatment for symptomatic COPD or reserved for patients most likely to benefit from ICS. This narrative review evaluates contemporary GOLD recommendations, major clinical trials, blood eosinophils as a treatment-response biomarker, mortality outcomes, and ICS-associated pneumonia risk. Evidence from IMPACT, ETHOS, TRIBUTE, FULFIL, TRILOGY, and other studies supports triple therapy in appropriately selected patients with established COPD, particularly those with previous exacerbations. However, most pivotal trials enrolled patients receiving maintenance inhalers, limiting direct extrapolation to treatment-naïve patients. Blood eosinophil counts, exacerbation history, concomitant asthma, and infection susceptibility should guide treatment selection. Indian publications additionally highlight challenges involving COPD awareness, diagnostic practices, inhaler access, and rational prescribing. LABA/LAMA remains the preferred initial treatment for most symptomatic patients without a compelling indication for ICS, whereas initial triple therapy may be considered in selected high-risk patients, particularly those with blood eosinophils ≥300 cells/µL. A phenotype-directed approach offers the most rational balance between exacerbation prevention, symptom control, and treatment-related harm.