Ill help any way I can IM no dr. by any means but I have been putiing up withis for 15yrs.now I know that it takes about 3or4 days for your body to ajust to the shock of sum of this stuff..If you have COPD your best frend will be the advair and the Spiriva I can only use the advir 250/50 cuz the 500/50 is to strong.........and it takes 8day to get the full affect of it.but you will see a big deference in 3 days..........Ill be here for ya..........Artie