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With a moderate certainty level, four studies and 13,614 participants contribute to a 77% outcome. The benefits of LAMA+LABA therapy for exacerbations and quality of life, assessed by the St George's Respiratory Questionnaire, for people with moderate to severe COPD appear comparable to LABA+ICS; however, it might show a greater improvement in the FEV. There is a reduced possibility of pneumonia developing, by a small margin. In terms of serious adverse event risk, LAMA+LABA and LAMA+ICS are near