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

A 68-year-old man with COPD (post-bronchodilator FEV1 45% predicted) has had two moderate exacerbations requiring oral steroids and one hospitalisation in the last year despite dual long-acting bronchodilator therapy (LABA/LAMA). According to Canadian COPD guidance, which change in inhaled therapy is most appropriate?

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