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Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are symptomatically defined, acute events that lead to a change in treatment1,2 and are associated with an accelerated decline in lung function and health status.3 Treatment with inhaled glucocorticoids reduces the exacerbation rate, especially when the drugs are used in combination with a long-acting ?-agonist (LABA).4,5 Consequently, combination therapy with an inhaled glucocorticoid and a LABA is recommended in patients with severe COPD or a history of frequent exacerbations.2 Long-acting muscarinic antagonists (LAMAs) have also been shown to prevent exacerbations.6?8 However, in patients with severe or very severe COPD and . . .
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