Afghanistan Specialization Entry Exam

Practice session

A 56-year-old male with a 20-pack-year smoking history presents with progressive dyspnea on exertion and chronic morning productive cough. Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.58 and an FEV1 of 62% of predicted. He reports two moderate exacerbations in the past year requiring antibiotics. According to GOLD guidelines, what is the most appropriate initial maintenance pharmacotherapy?

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