Barb; Not that I can afford it but if most would research they would find that Ultibro Breezhaler is probably the best inhaler for COPD there is a new article in LUNG NEWS about how it helps the heart google( Breezhaler and heart) but to me they have done many trials and it also raises fev1 the most, it has a 31% reduction in exacerbations. All this can be researched, they come out in India it's called Sequadra but ADC doesn't seem to carry it yet. The good dosage is 110/50 once a day but here in the FDA kingdom it is about a third of that twice a day. That way they can double their money. Wish I could afford it is about $320 for 90 days in Canada. God bless.