OBJECTIVES: To determine persistence rates and treatment patterns of the following long-acting drugs used as inhaled maintenance therapies for COPD: long-acting muscarinic antagonists (LAMA), long-acting ß2-agonists (LABA) and fixed dose combinations (FDC) of inhaled corticosteroids (ICS) and LABA. METHODS: From the PHARMO-database, all probable COPD patients were identified by new respiratory drug use (excluding ICS monotherapy) at age ≥ 55 years. New users of LAMA, LABA and FDC in the period 2002-2006 were included in the study. Persistence with the initial as well as any long-acting drug was determined up to three years after start and defined as time between start and stop of initial/any therapy, allowing a gap of ≤ 60 days between refills. For patients who failed to persist with initial therapy for one year, the first change in therapy was determined. RESULTS: The study included 4448 LAMA, 2019 LABA and 8341 FDC users. Persistence rates at 1, 2, and 3 years were 26%, 14%, 8% for LAMA, 23%, 10%, 6% for LABA and 27%, 14%, 8% for FDC. Of patients who did not persist with LABA alone for one year, 9% added therapy (mostly LAMA) and 31% switched therapy (mostly to FDC). Of patients not persisting with LAMA alone, 17% added and 12% switched therapy (both mostly relating to FDC). In patients not persisting with FDC, add-on and switch occurred with equal frequency (12%) and was mostly LAMA. Persistence rates with any long-acting drug at 1, 2 and 3 years were 37%, 23% and 17% respectively. CONCLUSIONS: Persistence with long-acting inhaled drugs in patients with COPD is low, with a substantial proportion of patients changing therapy. This indicates that current treatments are not adequate.