A 52-year-old man with COPD (GOLD Stage 2, FEV₁ 55% predicted) presents with persistent dyspnea and frequent exacerbations despite using tiotropium (long-acting muscarinic antagonist) once daily for 6 months. He denies smoking currently but has a 40 pack-year history. Chest X-ray shows no acute findings. What is the most appropriate next step in management?

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