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