A 52-year-old male smoker with a 30 pack-year history presents with progressive dyspnea and chronic cough. Spirometry shows FEV₁/FVC ratio of 0.68 (predicted 0.75), FEV₁ 58% predicted, and a normal inspiratory flow curve. Flow-volume loop demonstrates a characteristic 'scooped out' expiratory limb. What is the most appropriate next step in management?

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