Patient description: An 82-year-old woman comes to the emergency department because of chest pain and shortness of breath after being awakened in the morning by stabbing substernal chest pain radiating to the left shoulder and jaw. The patient had hypertension, renal-artery stenosis with chronic renal insufficiency, hypercholesterolemia, osteoporosis and dementia. Blood pressure was 199/108 mm Hg, respiratory rate 18 bpm, oxygen saturation 98% on ambient air. The heart sounds were rapid and with no murmurs. CK-MB was 10.9 ng/ml, CK was 89 U/l, CK index was 12.2% and Troponin T was 0.40 ng/ml. An EKG showed sinus regular tachycardia of 119 bpm, with ST-segment elevations up to 3 mm in V1, V2, and V3. A chest radiograph showed low lung volumes and right basilar subsegmental atelectasis. Coronary angiography showed no stenosis or clinically significant disease. Left ventriculography revealed akinesis of the anterior wall, hypokinesis of the apical and distal inferior walls, and compensatory hyperkinesis of the basal anterior and basal inferior walls. A transthoracic echocardiogram showed severe segmental left ventricular dysfunction involving the septum, anteroseptal territory, and apex. The overall left ventricular systolic function was mildly impaired and there was mild mitral regurgitation.

Clinical trial eligibility criteria: eligible ages (years): 40.0-80.0,  COPD Criteria:Participants with COPD with an FEV1 of 80−30% predicted. This will incorporate the majority of participants with COPD seen within the chest clinic. Patients with an FEV1 > 80% predicted are not generally severe enough to warrant hospital follow up. These patients are also unlikely to have severe enough disease (and therefore airway inflammation) which may be modified by the therapeutic agents we are studying Patients with an FEV1 < 30% tend to have more severe symptom limitation and generally (though not always) find participation in a clinical trial involving 4 visits to the clinic difficult. Their airway disease is also generally less responsive to therapeutic intervention and as a consequence finding measurements which show changes to these therapeutic interventions is more difficult COPD patients All participants will be classified to Stage 2−3 of the GOLD (Global initiative for Obstructive Lung Disease) guidelines Male or female, aged 45-80 years (according to GOLD guidelines) < FEV1 < 80% predicted FEV1/FVC < 70% Cigarette exposure of >10 pack−years# With or without chronic symptoms (cough, sputum production, dyspnea) Steroid therapy will be stopped before run−in, but long acting bronchodilators are acceptable  Any history or evidence of asthma Pregnancy, breast−feeding or planned pregnancy during the study. Fertile women not using acceptable contraceptive measures, as judged by the investigator Hospital admission with respiratory infection within the last 6 months Upper respiratory infection within the last 4 weeks Participants who have received research medication within the previous one month Participants unable to give informed consent Any mental condition rendering the participant unable to understand the nature, scope and possible consequences of the study Known or suspected hypersensitivity to study therapy or excipients Participants with significant or unstable ischemic heart disease, arrhythmia, cardiomyopathy, heart failure, uncontrolled hypertension as defined by the investigator, or any other relevant cardiovascular disorder as judged by the investigator Any current respiratory tract disorders other than COPD, which is considered by the investigator to be clinically significant