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MediumRespiratoryChronic obstructive pulmonary disease - stable pharmacologic managementca-mccqe1ca-ccfpca-rcpsc-im

A 70-year-old man with COPD (FEV1 45% predicted) remains breathless with mMRC dyspnoea score 3 and has had two moderate exacerbations requiring oral steroids in the past year. He currently uses a short-acting bronchodilator as needed but no long-acting inhalers. According to recent Canadian COPD pharmacotherapy guidance, what is the most appropriate next step?

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