This clinical trial is focused on studying Chronic Obstructive Pulmonary Disease (COPD), a long-term lung condition that makes it hard to breathe. The study will evaluate the effectiveness of a new treatment using a combination of medications delivered through an inhaler. The medications being tested include Budesonide, Glycopyrronium Bromide, and Formoterol Fumarate Dihydrate, which are combined in a product called Trixeo Aerosphere. This combination is compared to another inhaler treatment called Bevespi Aerosphere, which contains Glycopyrronium Bromide and Formoterol Fumarate Dihydrate. Additionally, the study involves the use of Salbutamol, a common medication for relieving breathing difficulties.

The purpose of the study is to assess how well these treatments work in improving heart and lung health in people with COPD. Participants will be randomly assigned to receive one of the treatments or a placebo. The study will last for up to 36 months, during which participants will use the inhalers as directed and attend regular check-ups to monitor their health. The study aims to determine the time it takes for participants to experience severe heart or lung-related events, such as worsening of COPD symptoms or heart problems.

Throughout the study, participants will be closely monitored to ensure their safety and to gather information on how the treatments affect their condition. The results of this study will help to understand the benefits and risks of using these inhaler medications for managing COPD and improving overall heart and lung health.