Practice question

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A 62-year-old man with COPD has an FEV1 of 48% predicted. He remains breathless despite using salbutamol as required and a regular LAMA inhaler (tiotropium). He has had two moderate exacerbations requiring oral steroids in the past 12 months. According to NICE guideline NG115, what is the most appropriate next step in his inhaler therapy?

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