The LABA/ICS combination is sometimes given either instead of a long-acting inhaled bronchodilator alone or in addition to a LAMA. In some patients, the LABA/ICS combination improves health-related quality of life and reduces the risk of a COPD exacerbation [67]. The combination also reduces the rate of lung function decline when compared with placebo, but not when compared with a LABA alone or ICS alone [125]. The LABA/ICS combination may have a modest effect on overall mortality [67]. The primary adverse effect attributed to the LABA/ICS combination is an increased risk of pneumonia, although this effect may not be present to the same degree with all formulations of a LABA/ICS [134, 135].