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MediumRespiratoryChronic obstructive pulmonary diseaseau-amcau-racgpau-racp

A 70-year-old former smoker presents with chronic productive cough and exertional dyspnoea. Spirometry confirms FEV₁/FVC 0.55 and FEV₁ 45% predicted with limited reversibility. He has had two exacerbations requiring oral steroids in the last year. According to the COPD-X Handbook, what is an appropriate next step in pharmacological management?

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