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

A 61-year-old man with long-standing smoking history presents with chronic cough and exertional dyspnoea. Spirometry confirms moderate COPD (FEV1 55% predicted) with frequent exacerbations despite a long-acting bronchodilator. According to the 2023 Canadian Thoracic Society COPD pharmacotherapy guideline, which change is most appropriate?

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