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MediumRespiratoryChronic obstructive pulmonary diseaseca-mccqe1ca-ccfpca-rcpsc-im

A 70-year-old man with GOLD stage 3 COPD (FEV₁ 35% predicted) remains dyspnoeic and has had two moderate exacerbations in the past year despite long-acting muscarinic antagonist (LAMA) monotherapy. According to the latest Canadian Thoracic Society COPD pharmacotherapy guideline, what is the most appropriate next step?

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