A 65-year-old male with a 40 pack-year smoking history presents with chronic cough, dyspnea on exertion, and recurrent wheezing. Spirometry shows FEV1/FVC ratio of 0.60 and FEV1 55% of predicted. After bronchodilator administration, the FEV1/FVC ratio remains 0.60 and FEV1 60% of predicted. Based on GOLD guidelines, what is the most appropriate initial long-term pharmacotherapy for this patient's symptoms?
✓ Correct Answer: Option C
This patient has moderate to severe COPD (FEV1 55%) with persistent symptoms. According to GOLD guidelines, a long-acting bronchodilator, such as a LAMA or LABA, is the initial pharmacotherapy for symptomatic patients.