I have a cavity. NJH put me on spiriva respimat 20 months ago. No side effects for me. I was also on Symbicort and taking both was a problem. I tried both one at a time and responded better to Spiriva and I took myself off symbicort. A fungal infection was setting in. I then discovered that steroids can fuel fungal infections. Multiple Doctors then concurred.
I will never take a long term steroid again.
For me, it is the lesser of two evils.