The introduction of longacting β2 agonists,1 inhaled steroids, [1], [2], [3], [4] and [5] fixed combination products, [1], [6], [7] and [8] and a longacting anticholinergic drug [9], [10], [11] and [12] __1__ treatment of patients with chronic obstructive pulmonary disease (COPD). These agents __2__ pulmonary function and quality of life, and reduce the frequency of exacerbations. [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11] and [12] Reduction of exacerbations __3__ especially important because they can accelerate the progression of the disease. [13] and [14] There __4__ also data to suggest that treatment with a longacting anticholinergic drug12 and a combination product6 __5__ mortality.