Thanks for the reply. I know folks on here are not docs but thought maybe someone else may have had the same type(s) of things noted. The post I provided was the report from a few days ago and they compared it to Oct 2015. The doctor hasn't called back so I figured I'd reach out the members for their take. I was taking Tudorza and Symbicort which I went back to recently. My pulmonologist had me try Trelegy which looking back is when things started going down hill. I have taken Spiriva and Advair in the past but when I fall in the gap I need to switch to Tudorza and Symbicort (both AZ medications) because I meet their income guidelines for PAP and with GSK I don't. Medications for COPD are out of control and I've been on them for over 10 years. One thing that was in my retirement plan. Add to that uncontrolled diabetes for 7 years, a heart attack and UC what more could a guy ask for ?? 🙂