Dear Lyonheart: I noticed you take Atrovent 3 xday; have you tried Spiriva? Atrovent has peaks and valleys, so your body does not have a continuous ability to stay open; Spiriva works for 24 hrs, so your body does not experience the peaks and valleys. It's a dry powder inhaler. I've worked w/lots of pts that have experienced good results with this med; also one med you don't have to worry about except once a day -- AM best time to take it.
Also, Xopenex now comes in a MDI form (still need aerochamber to receive correct doseage). Ck w/insurance to see if they will pay for it. As a resp therapist, I think it's one of the best advances in asthma management.