ICS stands for inhaled corticosteroid and it is often prescribed for COPD, either as a stand-alone med or as part of a combination med, such as Advair or Symbicort. Those two, and several other medications are combinations of long acting beta agonists (LABA) and ICS. Trelegy is a combination of the LABA and ICS, plus a long acting muscarinic agent (LAMA). One of the potential side effects of ICS meds is hoarseness, so what you are both experiencing isn't unusual. If you're a singer, it's a particularly nasty one and very difficult to deal with.

You can simply stop taking it. It's perfectly possible to take a LAMA/LABA combination without the ICS component. That might work for you. As for increased exercise or weight loss, both of those things can make a difference in how symptomatic your COPD is, and could lead to you not needing the ICS. What I'd suggest right now is talking with your pulmonologist about why they believe you need the ICS component and what might happen if you simply stopped taking it. Unless there's some compelling reason, your doc ought to be willing to let you try not using it to see what happens. In the meantime, you can start a good, sensible diet and exercise program and see how that works for you. You might be able to improve things enough that you won't need the ICS. Or you might decide that you won't take it and use the singing and exercise to help you work on breath control.

Lots of possibilities.....and most of them positive......

Sounds as if you've been given much good advice on this matter, but I wanted to add my thoughts as well. I was using inhalers for years and constantly suffered from bouts of oral thrush. Finally, my Pulmon. doc suggested switching to nebulized forms of the same, or comparable, medications. Doc explained that sometimes the inhaler medications don't get far enough into the lungs as they should, and many times much of the medication ends up sitting in the back of your throat, irritating it. Nebulized meds are not mixed with powder as inhalers are, and are able to get your medicine further into the lungs. It worked well for me, and I rarely experience oral thrush any longer. Might be something to consider.

All inhalers have side effects, and some of them affect some people in ways that don't bother others. Spiriva may be the culprit in your situation, but it might not be. Check with your doc to see if there's anything else that might have the effect you're experiencing. If the two of you decide it's the Spiriva, then you might try other LAMAs or combinations to see if you can find one that doesn't affect you that way.

I wasn't suggesting that breath control would help with your singing voice, I was simply suggesting if it turns out that the Spiriva has an effect on your voice and you choose to continue to take it, you could work on increasing your breath control. If you don't need to do that or don't see any value in doing that, then don't.

Some people do seem to be much more prone to developing thrush than others, and your pulmonologist's recognition of that and making the suggestion to nebulize the meds instead was great. Many people don't want to/can't do that because of the time nebulizing takes. The biggest difference between the nebulized version of the meds and the inhalers that often cause thrush is the nebulized versions are liquid and not dry powder, which is the major cause of thrush in people with COPD.

Thank you all so much for responding! I feel good enough (with weight loss, getting in much better shape, etc.) that I can 'experiment' with something other than inhalers containing the ICS. I had not thought of going the nebulizer route, but makes sense. I feel very fortunate that thrush hasn't been a problem, although it surely can be, for some. Breath control doesn't seem to be a problem. I've been grateful for al of the singing in my past, which has helped with my breathing. Lots of options, yes, and as you said Jeanne... most of them positive! Thank you all again! ❤️