Phase IV O2 Consumption Study in COPD Patients.

Patients with moderate/severe COPD are known to have static hyperinflation and to develop
dynamic hyperinflation during exercise. Treatment with inhaled long-acting beta agonists and
combination of the long-acting beta agonist (LABA), formoterol and the inhaled
corticosteroid, budesonide has been shown to improve IC and decrease lung hyperinflation. In
a similar previous pilot single centre study with budesonide/formoterol (Symbicort®) the
analysis of cardiac outcomes demonstrated a decrease in maximum volume of oxygen (VO2)
compared to placebo. Findings suggested that the use of Symbicort can decrease the cost of
breathing and therefore reduce the cardiac demand experienced by COPD patients with
hyperinflation at rest. The aim of this study is to investigate whether Symbicort therapy can
decrease resting VO2 by decreasing static lung hyperinflation in subjects with COPD and to
evaluate changes in cardiac function.

Inclusion Criteria:

1. Signing of the informed consent form (ICF) prior to any study specific procedures,
including withholding of medications.

2. Male or female, aged 40 to 80 years, inclusive, at Screening (Visit 1).

3. Has a clinical diagnosis of COPD according to the Global Initiative for Chronic
Obstructive Lung Disease (GOLD) 2014 guidelines with a post bronchodilator FEV1/FVC
<0.7 at Screening (Visit 1).

4. Has a post-bronchodilator FEV1 ≤65% of predicted value at Screening (Visit 1).
National Health and Nutrition Examination Survey (NHANES) predicted normal standards
will be used for all subjects.

5. Has an increase in IC of >10% after the administration of 1 inhalation of open-label
Symbicort pMDI administered with a spacer at Screening (Visit 1).

6. Has a cigarette smoking history of more than 10 pack-years (number of cigarettes
smoked per day × number of years smoked)/20).

7. Be able to understand and comply with study requirements, as judged by the
Investigator.

Exclusion Criteria:

1. Subject is an employee or relative of an employee involved in the planning and/or
conduct of the study (applies to both AstraZeneca staff and/or staff at the study
site).

2. Previous enrollment or randomization in this study.

3. Participation in another clinical study with an investigational product (IP) during
the last 30 days prior to Screening (Visit 1).

4. Subjects who are unable to discontinue their regular chronic COPD medications
(including LAMAs and/or LABA/ICS) and/or who are unable or unwilling to comply with
study requirements.

5. Subjects who are taking uLABAs (indacaterol, vilanterol) or uLABA-containing products.

6. Subjects who are taking PDE-4 inhibitors (roflumilast).

7. Subjects who are taking oral corticosteroids on a chronic, regular basis.

8. Subjects using daytime oxygen therapy.

9. Subjects who are currently pregnant (confirmed with positive pregnancy test) or breast
feeding.

10. History of respiratory tract infection (including the upper respiratory tract) and/or
pulmonary exacerbation within 6 weeks prior to Screening (Visit 1).

11. Pulmonary resection or lung volume reduction surgery within 12 months prior to
Screening (Visit 1), or history of lung transplantation, or, in the Investigator's
opinion, the subject may need thoracotomy or other lung surgery during the study.

12. History or current diagnosis of asthma and/or alpha 1 anti-trypsin deficiency.

13. Known active tuberculosis.

14. History of interstitial lung or massive pulmonary thromboembolic disease.

15. History of bronchiectasis secondary to respiratory diseases other than COPD (eg,
cystic fibrosis, Kartagener's syndrome, etc).

16. Any clinically significant disease or disorder (eg, cardiovascular, gastrointestinal,
liver, renal, neurological, musculoskeletal, endocrine, metabolic, psychiatric, major
physical impairment) which, in the opinion of the Investigator, may put the subject at
risk because of participation in the study, may influence the results of the study, or
may affect the subject's ability to participate in the study.

17. Recent (within 12 months prior to Screening [Visit 1]) history of myocardial
infarction, recent history of heart failure (New York Heart Association [NYHA] class
III and IV, pulmonary edema, and/or cardiac arrhythmia.

18. Previous or current history of lung cancer.

19. History of cancer (within 5 years prior to Visit 1), except for non-metastatic, non
melanoma skin cancer.

20. Subjects who cannot perform spirometry manuevers or tolerate body plethysmography.

21. Subjects with known hypersensitivity to Symbicort, its monocomponents (budesonide or
formoterol), or its excipients.