Inclusion Criteria:  Age greater or equal than 40: days [0,0] Diagnosis of COPD: days [-All Data, 0] History of at least 1 COPD exacerbation within the past year requiring treatment with antibiotics and/or systemic steroids and/or requiring hospitalization: days [-365, -28]  Exclusion Criteria:  Patients with 3 diagnosis of asthma: days [-180, 0] Patients with current severe cardiovascular disorders (Heart Transplantation, LVAD/Implantable heart, Pulmonary hypertension/other pulmonary disease) and use of systemic corticosteroid medication at unstable doses: days [-365, 0] Patients with any respiratory infection (Acute respiratory infections, pneumonia and influenza) or COPD exacerbation: days [-28, 0] Exclude use of salmeterol or tiotropium containing inhaler use [-180, 0]