Brief Answer:
It is not a duplication of meds

Detailed Answer:
Hello XXXXX,

Thanks for posting your query,

The 3 medications are not the same but Tiotropium bromide (Spiriva) and Fluticasone/salmeterol (Advair) both contain bronchodilators which can be used both the enhance the bronchodilating effect that both have to play. Ipratropium bromide (Atrovent) is used to treats a runny nose caused by colds or hay fever and may also treat COPD or Asthma. Your medications are simply a combination of steroids and bronchodilators which I guess your doctor prescribed all 3 together maybe because of the severity of your conditions. So I do not think they are exaggerated but if you feel they are bothersome you should talk with your doctor so he can decide if to step down or two of the agents.

I could not help but notice that you mentioned that you are still smoking. I do understand that it is most likely that your doctors and other health care providers must have tried to talk you out of it, given your present condition but I will still insist that smoking cessation is the single most effective therapy for the majority of COPD patients (emphysema) like yourself. You should try following through some smoking cessation plan which is essential part of a comprehensive treatment plan. If you really do care about your health (which I know that you do), you will think of a way of quitting smoking (if not for your sake, then for the sake of those who care about you).

Hope this helps and I wish you the best
Dr. Nsah

---