A Study to Investigate the Effect of Budesonide/Glycopyrronium/Formoterol Fumarate Metered Dose Inhaler (BGF MDI) Compared With Placebo MDI on Heart and Lung Function in Participants With Chronic Obstructive Pulmonary Disease (COPD) and Hyperinflation

Inclusion criteria

• Current or former smoker with a history of ≥ 10 pack-years of tobacco smoking.
• A diagnosis of COPD confirmed by a post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) \< 0.7.
• At Visit 1: A pre-bronchodilator FEV1 \< 80%.
• At Visit 1: Peripheral blood eosinophil count \< 300 cells/cubic millimeter (mm³), with no recorded history of eosinophil count \> 300 cells/mm³ in the past 12 months.
• At Visit 1: Modified Medical Research Council (mMRC) ≥ 1.
• At Visit 2: A pre-bronchodilator functional residual capacity (FRC) of \> 135% of predicted normal FRC.
• At Visit 2: A post-bronchodilator FEV1 ≥ 30% and \< 80% of the predicted normal value.
• Participants must be on mono-, dual-, or triple-inhaled maintenance COPD treatment.
• Female participants must either be not of childbearing potential or using a form of highly effective birth control.
• All women of child bearing potential must have a negative pregnancy test at the Visit 1.

Exclusion criteria

• A current diagnosis of asthma, asthma-COPD overlap, or any other chronic respiratory disease other than COPD, such as alpha-1 antitrypsin deficiency, active tuberculosis, lung cancer, lung fibrosis, sarcoidosis, interstitial lung disease, and pulmonary hypertension.
• History of a COPD exacerbation that required hospitalisation, or 2 or more COPD exacerbations that required systemic corticosteroids.
• History of myocardial infarction or acute coronary syndrome.
• History or current clinically significant atrial or ventricular arrhythmia to be confirmed by electrocardiogram (ECG).
• Participants with a cardiac implantable electronic device, including pacemaker, implantable cardioverter defibrillator, or cardiac resynchronization therapy.
• Participants with ECG QTcF interval at Visit 1 \> 460 milliseconds (ms) for males and \> 480 ms for females.
• Participants who have had a respiratory tract infection within 8 weeks prior to Visit 1 and/or during the screening/run-in period.
• Participants with lung lobectomy, lung volume reduction (during the study and within 3 months of Visit 1), or lung transplantation.