You are wise to raise concerns about the cumulative effect of Anticholinergics (LAMA meds) as part of our treatment regimen. I formerly raised these concerns in this Forum, mostly to be rebuffed by counter-logic. Remember, the same Anticholinergic danger exists with Over the Counter meds containing DXM - like Benadryl, cough syrup and Mucinex - among MANY others! 🤔. Your Doc will explain how much this "doubling" should concern you based on the severity of your Respiratory condition.
R Well.

Just received a letter from my insurance company rejecting my pulmo's pre-authorization for Breztri. They have listed 5 meds that I need to try 4 of them before medication authorization. They are: Anoro Ellipta, Breo Ellipta, Incruse Ellipta, Strierdi Respimat and Trelegy Ellipta. There is paperwork for the doc to mail in. The search will be ongoing, ugh!! I'm on my 3rd day of Medrol dose pack right now. Cough much improved. Most likely from the Breztri. Lucky to have insurance coverage, but they can be a pain...

@A MyCOPDTeam Member and RollandO, thanks for your replies. I'm on my last 7 day sample of Breztri and it seems to improve my breathing, even increased my Peak Flow reading. Side effects seem to be mostly a cough, sometimes sever, and mucus.
Not on my formulary, but insurance said would be ok with a prior authorization from doc. Sent message to pulmo, but she hasn't gotten back to me..as is usual for her. I've asked for a couple more samples to tide me over til we see what happens with insurance. I do agree with both of you about the cumulative effects of Anticholinergics. I even have an extensive list of OTC meds that have them. One of the potential side effects is Alzheimers - something I fear the most as my mom passed with it. But....I do want to breathe. I did use the nebulizer this afternoon with med and it did help a lot with my breathing. But still want to discuss the med with my pulmo before I start using it regularly - if she ever gets back to me.! I have been using Advair for 30 yrs. Was diagnosed with Asthma, which I do have, but believe that I also had COPD yrs before my diagnosis. I'll try to keep you posted.
PS Jeffery, love your little Kaiko. He reminds me of my Lucy. About the same size. She is an adopted Malti-Poo; she is a love and so much company. She's 12 yrs old now. Will be a sad day when she goes to doggie heaven.

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A MyCOPDT...

@A MyCOPDTeam Member Good idea...I'll try the Trelegy. Hope she has a sample to try.

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@JefferyMalone Thanks for the encouraging words Jeffery. I so want to be able to use Breztri and breathe a little better. I'm not giving up yet.