im currently taking advair, spiriva, hfa rescue inhaler and duoneb for the nebulizer. i was taking singulaire but was taken off of that when the pulmonary doctor ran across information that it may be contraindicated for those with PN. nothing firm yet but he took me off anyway. i havent noticed the spiriva having any differing effect either way on my pn than singulaire did. its such a tradeoff between taking medication and side effects. i not sure if you are familiar with FEV1 (forced expiratory volume) on pulmonary function tests but mine have dropped from 115% of expected down to now 43% of expected over the years.