American College of Physicians: Internal Medicine — Doctors for Adults ®

 
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A 62-year-old man is evaluated for declining exercise capacity over the past year. He was diagnosed with moderate COPD 3 years ago. His symptoms had previously been well controlled with tiotropium and as-needed albuterol. He has not had any hospitalizations. He is adherent to his medication regimen, and his inhaler technique is good. Following a physical exam and review of previously performed chest radiographs and pulmonary function testing, what is the most appropriate management?

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