AKT-5707
A 72-year old woman with a recent diagnosis of chronic obstructive pulmonary disease (COPD) is seen.
Her spirometry shows an FEV1 of 42% predicted with an FEV1: FVC ratio of 64%. Her current treatment consists of a short-acting beta agonist (SABA) used as required which was started when a clinical diagnosis was made following the spirometry.
On reviewing her symptoms she needs to use the SABA at least four times a day and despite this still feels persistently breathless. In addition, she tells you that over the last few years she gets attacks of ‘bronchitis’ requiring antibiotics two to three times a year.
According to NICE guidance, which of the following is the next most appropriate step in her pharmacological management?