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COPD trials lasting longer than six months often have large numbers of people leaving the trial early. In INSPIRE, the largest trial in our review comparing fluticasone/salmeterol to tiotropium, there were seven to eleven times more people leaving the trial early than the number who died; a number that swamps the death rate. Therefore we felt unable to draw a reliable conclusion as to which treatment has the lowest mortality rate. This uncertainty also left us unable to reliably say which drug was better in terms of reducing COPD exacerbations, hospitalisations, serious adverse events or improving quality of life and health status.