Exacerbations are associated with higher mortality, a reduction in lung function, and worsening of health-related quality of life(Almagro and Castro 2013). Exacerbations are described by NICE as ‘distressing and disruptive for patients, and account for a significant proportion of caring for patients with COPD’. Commonly reported Exacerbations include worsening breathlessness, cough. and increased sputum production and change in sputum color, and these often necessitate a change in medication. If exacerbations persist ,recommends ’triple therapy’ -the combination of a LABA, an inhaled corticosteroid and a LAMA.