Spiriva is Ipratropium bromide and can be used by nebulizer if your insurance will cover it. You have to use it more often 3-4 times a day. I couldn't afford Spiriva either; it put me in the doughnut hole every year, My primary suggested the nebs because they are not as drying on the mouth and my medicare pays for the medication,

I am finding I have good relief with Breo Ilipta and Ultibro Breezehaler, much better since I have been using these they are only new out on the market.

I found I had no relief,with Spiriva Serotide, or Onbreeze, but I have had great relief with useing the new Inhalers thaT have just come on the market called Breo Ellipta, and Ultibro breezehaler, used once per day in the morning.

Goood luck with these Inhalers.

You can use Symbicort or Dulera in place of Spiriva. What does your insurance recommend you use?

Yes, I had to change to Tudorza. It works for me. But I found Tudorza very bitter.