Patient description: A 10 year old child is brought to the emergency room complaining of myalgia, cough, and shortness of breath. Two weeks ago the patient was seen by his pediatrician for low-grade fever, abdominal pain, and diarrhea, diagnosed with a viral illness, and prescribed OTC medications. Three weeks ago the family returned home after a stay with relatives on a farm that raises domestic pigs for consumption. Vital signs: T: 39.5 C, BP: 90/60 HR: 120/min RR: 40/min. Physical exam findings include cyanosis, slight stiffness of the neck, and marked periorbital edema. Lab results include WBC 25,000, with 25% Eosinophils, and an unremarkable urinalysis.

Clinical trial eligibility criteria: eligible ages (years): 40.0-80.0,  Pulmonary Disease, Chronic Obstructive Type of subject: outpatient Informed consent: Subjects must give their signed and dated written informed consent to participate Gender: Male or female. Female subjects must be post-menopausal or using a highly effective method for avoidance of pregnancy. The decision to or women of childbearing potential may be made at the discretion of the investigator in accordance with local practice in relation to adequate contraception Age: >=40 and <=80 years of age at Screening (Visit 1) Tobacco use: Subjects with a current or prior history of >=10 pack-years of cigarette smoking at screening (Visit 1). Previous smokers are defined as those who have stopped smoking for at least 6 months prior to Visit 1 Airflow Obstruction Subjects with a measured post-albuterol/salbutamol forced expiratory volume in 1 second (FEV1)/(forced vital capacity)FVC ratio of <=0.70 at Screening (Visit 1) Subjects with a measured post-albuterol/salbutamol FEV1 >=50 and <=70% of predicted normal values calculated using III reference equations [Hankinson, 1999; Hankinson, 2010] at Screening (Visit 1) Post-bronchodilator spirometry will be performed approximately 15 minutes after the subject has self-administered 4 inhalations (i.e., total 400mcg) of albuterol/salbutamol via a metered dose inhaler (MDI )with a valved-holding chamber. The FEV1/FVC ratio and FEV1 percent predicted values will be calculated Symptoms of COPD: Subjects must score 2 or higher on the modified Medical Research Council Dyspnea scale (Visit 1)  Pregnancy: Women who are pregnant or lactating Asthma: Subjects with a current diagnosis of asthma. (Subjects with a prior history of asthma are eligible if they also have a current diagnosis of COPD) alpha 1-antitrypsin deficiency: Subjects with known alpha-1 antitrypsin deficiency as the underlying cause of COPD Other respiratory disorders: Subjects with active tuberculosis, lung cancer, bronchiectasis, sarcoidosis, pulmonary fibrosis, pulmonary hypertension, interstitial lung diseases or other active pulmonary diseases Lung resection or transplantation: Subjects with lung volume reduction surgery within the 12 months prior to Screening or having had a lung transplant A moderate/severe COPD exacerbation that has not resolved at least 14 days prior to Visit 1 and at least 30 days following the last dose of oral corticosteroids (if applicable) Current severe heart failure (New York Heart Association class IV). Subjects will also be excluded if they have a known ejection fraction of <30% or if they have an implantable cardioverter defibrillator (ICD) Other diseases/abnormalities: Any life-threatening condition with life expectancy <3 years, other than vascular disease or COPD, that might prevent the subject from completing the study End stage chronic renal disease: Subjects will be excluded if on renal replacement therapy (hemodialysis or peritoneal) Drug/food allergy: Subjects with a history of hypersensitivity to any of the study medications (e.g. beta-agonists, corticosteroid) or components of the inhalation powder (e.g. lactose, magnesium stearate). In addition, patients with a history of severe milk protein allergy that, in the opinion of the study physician, contraindicates the subject's participation will also be excluded