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Introduction Reducing the risk of exacerbations is a key objective of COPD management. Recently published studies have demonstrated that GLP-1RAs used for weight loss also have benefits on respiratory outcomes within asthma. 1 Aims The aim of this study was to use real-world data from the Optimum Patient Care Research Database (OPCRD) to determine whether respiratory benefits might extend to a COPD population & Type 2 Diabetes.Methods Our exposed cohort were prescribed a GLP-1RA, and had a diagnosis of COPD, type 2 diabetes, were over 40 years old at the time of the first GLP-1RA (index date). We identified an age, sex, smoking status and BMI matched control cohort of patients with COPD and diabetes who were contributing data to OPCRD at the time of their matched patients index date, their COPD treatments and number of exacerbations in the year prior to the GLP-1RA prescription.Exacerbation outcomes included a) specific exacerbation measure (chest infection type diagnosis with an antibiotic or steroid prescription), b) sensitive exacerbation measure (antibiotic or steroid prescription without a chest infection type diagnosis), c) OCS prescriptions and d) hospital admissions in the year following GLP1 initiation.Results The cases mean age was 66, 58% were male, the mean BMI was 36.25. Cases GOLD (2023) group classification were 16% A, 55% B, and 29% E. Controls were comparable. Patients receiving a GLP-1RAs had significantly lower risk of exacerbations (specific IRR 0.84: 0.79–0.89 p<0.001, sensitive IRR 0.89: 0.84–0.95 p=0.003). Cases had lower OCS prescriptions (IRR 0.86: 0.77–0.95 p<0.001) and respiratory hospitalisations (IRR 0.61: 0.41–0.74 p<0.001) compared with controls.Abstract S102 Figure 1Conclusions This real-world study provides evidence that GLP-1RAs therapy maybe associated with a lower risk of COPD exacerbations in patients with comorbid T2D suggesting a potential protective effect of GLP-1 RAs on respiratory health. Furthermore, an approximately 20% lower risk in exacerbations and corticosteroid prescriptions, is clinically meaningful, especially in a population with high multimorbidity burden. Large scale randomised trials are now needed to test this potential.Reference Kaplan A, Heatley H, Townend J, et al. The real-world impact of glucagon-like peptide 1 receptor agonists on asthma control in people with high-risk asthma and obesity. Adv Ther. 2025.