Inhaled Corticosteroids (ICS) on Pulmonary Endothelial Function in COPD

The study objective is to determine whether an ICS added for 4 weeks to a baseline treatment with a Long-Acting Beta-adrenergic Agonist (LABA) and Long-Acting Muscarinic Antagonist (LAMA) combination improves pulmonary vascular endothelial function as assessed by the vasodilator response to inhaled albuterol (endothelium-dependent vasodilation) in stable COPD patients treated with a LABA/LAMA without an ICS for at least one month.

Inclusion Criteria: * physician diagnosis of COPD * former smoking history of more than 10 pack-years * baseline post-bronchodilator one-second forced expiratory volume (FEV1) 50-80% of predicted, baseline FEV1 and forced vital capacity (FVC) ratio \<0.7 * males and females, 40-80 years of age * regular use of a LAMA/LABA drug regimen for at least a month Exclusion Criteria: * women of childbearing potential who do not use accepted birth- control measures * pregnant and breast-feeding women * respiratory infection within 4 weeks of a test day * a Corona Virus Disease (COVID) vaccination \<3 months prior to study entry * ICS use (within 4 weeks of study entry) * ICS hypersensitivity * albuterol intolerance * use of beta-blocker medication (oral and ophthalmic) * use of systemic glucocorticosteroid medication within 6 wk prior to the screening visit * an acute COPD exacerbation within 6 wk of the screening day (defined as a need for antibiotic or systemic glucocorticoid therapy or emergency department (ED) visit/hospitalization) * current smoking or vaping tobacco or other products * Oxygen (O2) saturation of \<90% at-rest breathing room air * Long-term oxygen therapy (LTOT) required at rest * regular use of pulmonary vasodilators * systemic arterial systolic pressure \>150 mmHg and diastolic pressure \>100 mmHg on the test day * a \>40mmHg right ventricular systolic pressure (RVSP) by prior echocardiography * a documented COVID infection within 4 weeks of the screening day * Regular use of home oxygen at rest * Physician diagnosis of obesity hypoventilation syndrome