DiscussionResults of this real-world COPD study may help to inform treatment decisions for COPD patients at risk of an exacerbation. The outcome of prolonged time to first exacerbation with an inhaled ICS/LABA (BFC) compared to a LAMA (tiotropium) is clinically meaningful and important to patients, clinicians, and health care systems. While this is a non-randomized retrospective study using claims data, propensity score matching to define the study cohorts provides confidence that the groups were comparable at index evaluation and supports a difference in COPD exacerbation protection between the two medication classes.