Jay said that he has been experiencing these symptoms for many years, just not as symptomatic as it has been this time. He has never been hospitalized secondary to his shortness of breath. He explained that there were times in the past few years when he had felt short of breath on exertion for a couple of weeks. Additionally, during these times his cough was significantly worse. He explains that his main problem is the shortness of breath and his persistent cough. He is finding it increasingly more difficult to expectorate sputum secondary to his cough. Jay has been smoking for 30 years, about 30-pack years. He lives with his wife who is in good health and is able to drive him home upon discharge.

With this new information, how would you proceed?