A 58-year-old with COPD has an FEV1/FVC ratio of 0.62 and FEV1 of 48% predicted. He remains symptomatic on LABA monotherapy. What is the most appropriate next step?
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A
Add inhaled corticosteroid (ICS)
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B
Add long-acting muscarinic antagonist (LAMA)
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C
Start oral theophylline
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D
Initiate roflumilast