No clinically relevant differences were observed between LAMA+LABA combination therapies and LAMA monotherapy. The effectiveness of LAMA+LABA combinations in preventing exacerbations was only assessed with indacaterol / glycopyrronium, with modest results. The validity of comparative studies of LAMA+LABA vs. LABA+ corticosteroids was compromised by pre-trial exclusions of specific patients, and the inclusion of patients for whom a LABA+corticosteroid was contraindicated. A lack of scientific evidence exists to support the use of LAMA+LABA as first-choice therapy for COPD.