Q. A 26-year-old woman presents with complaints of chronic productive coughing and shortness of breath. She was diagnosed with cystic fibrosis at the age of 12. On physical examination, the patient has a barrel chest, digital clubbing, and decreased breath sounds in both lung fields. The patient's current weight is 97 lbs. and is 5’5” in height. Laboratory findings reveal a sweat chloride level of 66 mmol/L, white blood cell count of 10,500/?L with a normal neutrophil count and C-reactive protein level of 6.2 mg/L. Her spirometry shows FEV1 of 50% predicted. Chest x-ray reveals bilateral hyperinflation and evidence of lung parenchymal disease. What is the most appropriate management for this patient?