MRCP2-4431

MRCP2-4431

A 65-year-old man visits his primary care physician with complaints of frequent wheezy exacerbations. He has a medical history of chronic obstructive pulmonary disease and is an ex-smoker with a 35 pack-year history. He takes salbutamol as needed and denies any history of asthma or atopy. He does not consume alcohol.

During the examination, the patient appears comfortable at rest, and a mild expiratory wheeze is audible in the midzones. The jugular venous pulse is not elevated, and there is no peripheral edema.

The patient’s blood tests reveal normal levels of Hb, platelets, WBC, Neuts, Lymphs, Mono, Na+, K+, Urea, and Creatinine. Previous investigations did not show significant variation in FEV1 over time or substantial diurnal variation in peak expiratory flow.

What medication should be added to the patient’s regimen?