Soru

A 64-year-old man presents to the emergency department due to a 2-week history of progressive dyspnea on exertion, orthopnea, and a persistent dry cough. His medical history includes seropositive rheumatoid arthritis, type 2 diabetes mellitus, and a 35-pack-year smoking history. His joint disease was previously inadequately controlled with methotrexate monotherapy, prompting the addition of adalimumab 6 months ago, which has successfully induced clinical remission.

On physical examination, his temperature is $37.4^\circ C$ ($99.3^\circ F$), blood pressure is $148/90\ mmHg$, heart rate is $108/min$, and respiratory rate is $24/min$. Pulse oximetry shows $91\%$ on room air. Jugular venous distention is prominent up to the angle of the mandible while the patient is seated at a 45-degree angle. Auscultation reveals diffuse bilateral expiratory wheezes and coarse crackles at the lung bases. Bilateral 2+ pitting edema is noted up to the mid-calves.

Laboratory results:
Leukocytes: $8,500/mm^3$
Hemoglobin: $11.2\ g/dL$
Brain natriuretic peptide (BNP): $840\ pg/mL$ (Normal $< 100$)
Thyroid-stimulating hormone (TSH): $3.8\ \mu U/mL$ (Normal $0.5 - 5.0$)

Arterial blood gas (room air):
pH: $7.48$
$PaCO_2$: $31\ mmHg$
$PaO_2$: $64\ mmHg$
$HCO_3^-$: $23\ mEq/L$

Which of the following is the most appropriate next step in management?