Inhaled Corticosteroids (ICS) on Pulmonary Endothelial Function in COPD

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