Fig. 1

SPIRIT Figure of the trial procedure, including enrolment, data collection, interventions and assessments. COPD staging is performed as GOLD stage I–IV based on FEV₁%pred and GOLD group A-D based on exacerbation frequency and CAT score [25]. Maintenance treatment includes COPD and cardiovascular treatment in the following groups: Long-acting muscarinic antagonists; long-acting beta-2-agonists; inhaled corticosteroids; roflumilast; long-term oxygen therapy; other COPD treatment, including azithromycin and teofyllamin; ACE/AII-inhibitors; calcium-inhibitors; diuretics; and class I–IV anti-arrhythmics. BP blood pressure, CAT COPD Assessment Test, COPD chronic obstructive pulmonary disease, ECG electrocardiography, FEV₁ forced expiratory volume in 1 s, GOLD Global initiative for Obstructive Lung Disease, HR heart rate