Okay here is go.
I have used Spiriva, Trelegy. Advair, Breztri and others over the years and can say I never really noticed a difference when using them.
Recently my Pulmonary doc put me on the following nebulizer medication: Budesonide, Yupelri and Formoterol, and of course Ipratropium Bromide/Albuterol.
Like others, I hated using the nebulizer because of the time it took. However, now I happy use it!
1. The additional saline solution helps thin the mucus in my lungs so I can cough easier.
2. I believe I am actually getting a benefit from the medication vs the Powder getting stuck in my throat. Breathing much better for longer periods of time.

Only advantage to nebulizer meds is they are covered under Medicare but the Trelegy isn't and I have a $25 co-pay with my Medicare part D insurer.

That is the same nebulizer meds I was on but my pulmonist switched me to Trelegy a year ago and it is having the same results and so much more convenient and less time consuming. WallyMac

Thanks. That is the,same regime I am on.

Oh, I also use Breztri twice/day...