The LABA/ICS combination is equivalent to a LAMA in exacerbation prevention in the only direct comparison with a LAMA [136]. Several other outcomes (i.e. health status and mortality) favour the LABA/ICS combination over the LAMA, but confidence in these results is limited by the small number of events [136]. Adding a LAMA to the LABA/ICS combination appears to reduce the rate of severe exacerbations and improve symptoms in patients with moderate or severe COPD [137].