Interesting last name there Dr. Grief!   My husband uses a Combivent Inhaler, the company changed the delivery system due to " environmental concerns". The MDI is no longer called that and now has an annoying twist, turn, etc. hold, inhale. Who do I address my complaint to regarding this new delivery system. How on earth can people with nasty arthritis manage this new delivery system!?
You can try using sere tide accurate as it is very easy to use and less effort Dependent.Also, u can give a try to nebulization therapy and use forecourt by Ripley as res pules which has a long acting bronchodilator for the first time