Extension Study to Evaluate the Safety and Efficacy of PT003, PT001, and PT005 in Subjects With Moderate to Very Severe COPD, With Spiriva® Handihaler® (PINNACLE 3)

Key Inclusion Criteria:

- Participant in/completion of previous 24-week PINNACLE Phase III Trial.

- Male or female subjects at least 40 years of age and no older than 80 at Visit 1.

- Subjects with an established clinical history of COPD as defined by the American
Thoracic Society (ATS)/European Respiratory Society (ERS)

- Current or former smokers with a history of at least 10 pack-years of cigarette
smoking.

- Subjects with FEV1/forced vital capacity (FVC) ratio of <0.70 and FEV1 <80% predicted
normal and ≥750 mL if FEV1 <30% of predicted normal value.

- Subjects willing and, in the opinion of the investigator, able to adjust current COPD
therapy as required by the protocol

Key Exclusion Criteria:

- Significant diseases other than COPD, i.e. disease or condition which, in the opinion
of the investigator, may put the patient at risk because of participation in the
study or may influence either the results of the study or the subject's ability to
participate in the study

- Current diagnosis of asthma or alpha-1 antitrypsin deficiency

- Other active pulmonary disease such as active tuberculosis, lung cancer,
bronchiectasis, sarcoidosis, idiopathic interstitial pulmonary fibrosis, primary
pulmonary hypertension, or uncontrolled sleep apnea

- Hospitalized due to poorly controlled COPD within 3 months prior to screening or
during the Screening Period

- Poorly controlled COPD, defined as acute worsening of COPD that requires treatment
with oral corticosteroids or antibiotics within 6 weeks prior to screening or during
the Screening Period

- Lower respiratory tract infections that required antibiotics within 6 weeks prior to
screening or during the Screening Period

- Unstable ischemic heart disease, left ventricular failure, or documented myocardial
infarction within 12 months of enrollment.

- Recent history of acute coronary syndrome, percutaneous coronary intervention,
coronary artery bypass graft within the past three months

- Congestive heart failure (CHF) New York Heart Association (NYHA) Class III/IV)

- Clinically significant abnormal 12-lead electrocardiogram (ECG)

- Abnormal liver function tests defined as alanine transaminase (ALT), aspartate
transaminanse (AST), or total bilirubin ≥ 1.5 times upper limit of normal at Visit 1
and on repeat testing

- Cancer not in complete remission for at least five years

- History of hypersensitivity to β2-agonists, glycopyrronium or other muscarinic
anticholinergics, lactose/milk protein or any component of the MDI

Other protocol-defined inclusion/exclusion criteria may apply