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A 65-year-old male with GOLD Group C COPD (FEV₁ 45% predicted, 2 exacerbations i...

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A 65-year-old male with GOLD Group C COPD (FEV₁ 45% predicted, 2 exacerbations in the past year) presents with persistent dyspnea despite using tiotropium once daily. He has no history of asthma or eosinophilia. Which treatment is the best next step?

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