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92 (95% CI 0.75-1.12). The incidence of exacerbation on LAMA was significantly lower than on LABA (HR 0.88; 95% CI 0.80-0.96) among patients with a prior exacerbation, and the HR of exacerbation increased with percent predicted FEV1. This study in the real world clinical setting of COPD treatment found that using a LAMA or a LABA (no ICS) as the initial bronchodilator is generally as effective at reducing exacerbation incidence and frequency. However, a LAMA may be more effective in patients with prior exacerbations, which supports the GOLD recomm

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