Are you on O2? If not, then probably you should be. When you see the new pulmonologist, talk with her about getting tested for supplementary O2 and about your frustration with Spiriva. It's possible that your technique in taking it is off enough to make a difference. I would find it hard to believe that you wouldn't respond to one or another of the meds in the same classification as Spiriva, since they all target receptors in the bronchial tubes. The conclusion may be that the meds aren't getting where they need to go because your technique is off, so be sure to demonstrate how you take it. Make sure they demonstrate and make you show them how to do it properly.

There are only so many classes of inhaled meds for us. Basically it's short and long acting bronchodilators, anticholinergics and inhaled steroids. After that, it's really just different combinations of the same classes of meds. So while there's more choices than there used to be because of all the various combinations, there really aren't any new classes of meds. You've apparently written off the anticholinergics since you think neither Spiriva or Incruse worked for you.

All that said, one of the best things we can do for ourselves after we quit smoking is exercise. No one, including your pulmo, expects you to go join a gym and be able to walk three miles every day from the get-go. What is possible, however, is to slow way down and walk as long as you can without having to stop and catch your breath. If you take off at what you think of as a normal pace, you'll run yourself out of breath in a couple of minutes, maybe less. Then you do it again and again, same amount of time, until you've walked 30 minutes total. Do the same thing every day for the next three or four days until that amount of time seems a bit easier to do. Then add a minute or two before you allow yourself to stop and catch your breath. Keep adding time a little bit every three or four days until you can do 30 minutes without stopping. Once you can do 30 minutes you can add speed, distance or time.

At the same time, you do need to be working with weights. You'll find that strong, well toned muscles can do a whole lot more with a lot less O2 than weak, flabby ones. Do exercises designed to strengthen you upper, lower and core muscle groups. Your doc was right about what you should do; he just wasn't very diplomatic about how he put it.

Both Spiriva and Symbicort are maintenance medications, so you don't see any immediate effect of either one, although I believe some folks do feel that Symbicort does do something immediately. To answer your question about Breo and Symbicort, no you can't take them together. They're both a combination of a long acting bronchidilator and a steroid, so to take them together would be double dosing on both meds in the combination.

The only way you'll know whether the Spiriva is having any effect is to stop taking it for probably two weeks to a month and see if your breathing is any worse. If not, then you're right, it's not doing you any good and you might as well quit taking it. My guess is that you'll notice that your breathing is worse after a week or so, and that will tell you that it is doing something for you, even though it may not be doing as much as you'd like. There are other meds in the same class as Spiriva: Tudorza, Seebri and Incruse are all anticholinergics just like Spiriva and you might find one of them will work better for you.

Dr put me on encruze took me off anoro so I take advair twice a day once in the morning and at bed time take encruze midday I have seen alot of improvement

Is trelegy good?

I stopped mixing dry inhalers with wet inhalers.