Clinical Research Directory

Inclusion criteria Patients had to meet all of the following inclusion criteria to be eligible for enrolment into the study: 1. Male and female adults aged ≥ 40 years with written informed consent obtained prior to any study-related procedure; 2. Patients with a diagnosis of COPD (according to GOLD 2015 strategic document, updated January 2015) at least 12 months before the screening visit; 3. A smoking history of at least 10 pack years \[pack years = (number of cigarettes per day x number of years)/20\]. Current and ex-smokers were eligible; Note: Smoking cessation therapy had to be completed 6 months prior to screening visit. 4. A post-bronchodilator FEV1 \< 50% of the predicted normal value and a post-bronchodilator FEV1/FVC ratio \< 0.7 at least 10-15 mins after 4 puffs (4 x 100 μg) of salbutamol pMDI; 5. A documented history of at least one exacerbation in the 12 months preceding the screening visit. COPD exacerbation was defined according to the following: "A sustained worsening of the patient's condition (dyspnoea, cough and/or sputum production/purulence), from the stable state and beyond normal day-to-day variations, that is acute in onset and necessitates a change in regular medication in a patient with underlying COPD that includes prescriptions of systemic corticosteroids and/or antibiotics or need for hospitalisation"; 6. Patients under therapy for at least 2 months prior to screening with either: * ICS/LABA or * ICS/LAMA or * Inhaled LABA and inhaled LAMA or * LAMA or * LABA. 7. A cooperative attitude and ability to be trained to use correctly the study treatment inhalers (pMDI and Turbuhaler®); 8. A cooperative attitude and ability to be trained to use correctly the COPD questionnaires. All inclusion criteria were checked at screening (V1, Week -2). If criterion #4 was not met at V1, the test could be repeated once before the randomisation visit (V2, Week 0). Inclusion criteria #7 and #8 were to be re-checked at the randomisation visit (V2, Week 0). Exclusion Criteria: If a patient met any of the following criteria, he/she was not enrolled into the study: 1. Pregnant or lactating women and all women physiologically capable of becoming pregnant (i.e. women of childbearing potential) UNLESS are willing to use one or more of the following reliable methods of contraception: * Placement of an intrauterine device or intrauterine system; * Hormonal contraception (implantable, patch, oral); * Barrier methods of contraception: condom or occlusive cap (diaphragm or cervical vaults/caps) with spermicidal foam/gel/film/cream/suppository; * Male sterilisation (with the appropriate post-vasectomy documentation of the absence of sperm in the ejaculate). Reliable contraception had to be maintained throughout the study until last study visit. "True abstinence" was acceptable only if it was in line with the preferred and usual lifestyle of the patient. Pregnancy testing was carried out during the course of the study in all women of childbearing potential: serum pregnancy test was performed at screening (V1) and end of treatment (V6); and urine pregnancy test was performed at all visits except V0 and V6. Any postmenopausal women (physiologic menopause defined as "12 consecutive months of amenorrhea") or women permanently sterilised (e.g. tubal occlusion, hysterectomy or bilateral salpingectomy) could have been enrolled in the study; 2. Diagnosis of asthma, history of allergic rhinitis or atopy (atopy which may raise contra-indications or impact the efficacy of the study according to Investigator's judgement); 3. Patients requiring use of the following medications: * Systemic steroids for COPD exacerbation in the 4 weeks prior to screening; * A course of antibiotics for COPD exacerbation longer than 7 days in the 4 weeks prior to screening; * Phosphodiesterase E (PDE) inhibitors in the 4 weeks prior to screening; * Use of antibiotics for a lower respiratory tract infection (e.g. pneumonia) in the 4 weeks prior to screening; 4. COPD exacerbation requiring prescriptions of systemic corticosteroids and/or antibiotics or hospitalisation during the run-in period; 5. Changes in dose, schedule, formulation or product of oral xanthine derivatives (e.g. theophylline) in the month prior to screening visit or during the run-in period. Stop of xanthines prior to screening visit was allowed; 6. Patients treated with non-cardioselective β-blockers in the week preceding the screening visit or during the run-in period; 7. Patients treated with long-acting antihistamines (e.g. astemizole, terfenadine) unless taken at stable regimen at least 2 months prior to screening and to be maintained constant during the study, or if taken as required (PRN); 8. Patients requiring long term (at least 12 hours daily) oxygen therapy for chronic hypoxaemia; 9. Known respiratory disorders other than COPD which may impact the efficacy of the study treatment according to the Investigator's judgement. This can include but is not limited to alfa-1 antitrypsin deficiency, active tuberculosis, lung cancer, bronchiectasis, sarcoidosis, lung fibrosis, pulmonary hypertension and interstitial lung disease; 10. Patients who had a clinically significant (CS) cardiovascular condition (such as but not limited to unstable ischaemic heart disease, New York Heart Association (NYHA) Class III/IV, left ventricular failure, acute myocardial infarction), advanced atrio-ventricular conduction blocks; 11. Patients with atrial fibrillation (AF): * Paroxysmal (i.e. intermittent); * Persistent as defined by continuous AF diagnosed for less than 6 months; * Persistent for at least 6 months with a resting ventricular rate ≥ 100/minute controlled with a rate control strategy (i.e. selective β-blocker, calcium channel blocker, pacemaker placement, digoxin or ablation therapy); 12. An abnormal and CS 12-lead ECG that results in an active medical problem which may impact the safety of the patient according to Investigator's judgement. Patients whose ECG (12 lead) showed Fridericia-corrected QT interval (QTcF) \> 450 ms for males or QTcF \> 470 ms for females at screening and at randomisation visits were not eligible. 13. Medical diagnosis of narrow-angle glaucoma, clinically relevant prostatic hypertrophy or bladder neck obstruction that in the opinion of the Investigator would prevent use of anticholinergic agents; 14. History of hypersensitivity to M3 antagonists, β2-agonist, corticosteroids or any of the excipients contained in any of the formulations used in the trial; 15. Clinically significant laboratory abnormalities indicating a significant or unstable concomitant disease which may impact the efficacy or the safety of the study treatment according to Investigator's judgement; 16. Patients with serum potassium levels \< 3.5 mEq/L (or 3.5 mmol/L) at screening; 17. Unstable concurrent disease: e.g. uncontrolled hyperthyroidism, uncontrolled diabetes mellitus or other endocrine disease; uncontrolled gastrointestinal disease (e.g. active peptic ulcer); neurological disease; uncontrolled haematological disease; uncontrolled autoimmune disorders, or other which may impact the feasibility of the results of the study according to Investigator's judgement; 18. History of alcohol abuse and/or substance/drug abuse within 12 months prior to screening visit; 19. Participation in another clinical trial where investigation drug was received less than 8 weeks prior to screening visit; 20. Patients treated with Traditional Chinese Medicines used for respiratory diseases. All exclusion criteria except for criterion #4 were checked at screening (V1, Week -2). The following exclusion criteria were to be re-checked at the randomisation visit (V2, Week 0): #1, #4, #5, #6, #7, #10, #11, #12, #17, and #20. For patients in South Korea (only), the following were added to the South Korea-specific protocol (version 3.0): * For exclusion criterion #14, it was additionally specified that patients with a history of lactose intolerance were to be excluded; * For exclusion criterion #17, it was additionally specified that patients with a known history of hypersensitivity to sympathomimetic amine were to be excluded; * An additional exclusion criterion (#21) was specified for patients with a known history of hypertrophic cardiomyopathy.