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MediumRespiratoryStable COPD managementau-racpau-amc

A 68-year-old ex-smoker with COPD (post-bronchodilator FEV1 45% predicted) has daily dyspnoea on exertion and two moderate exacerbations requiring oral steroids in the past year. He currently uses tiotropium alone. According to COPD management recommendations, what is the most appropriate next step?

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