### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
have copd .. d/g was air sacks getting hard......do I use spiriva or combivent........i got TB 42 years ago in USMC and was treat for that ......VA say may have caused copd   scarred right lung....got pneumonia 3 times while in the jungle....also ischemic heart disease (3 stents)       abdominal aneurysm of the aorta ( 1 big stent) and bladder cancer removed 4 tumors and had full bcg treatment twice    VA says some from agent orange.... but they are not very helpful, I use my personal doctors and not VA. Many of my brother Marines have died of these same problems lately.     Question is about spiriva and combivent   and any thoughts about agent orange and my medical problems....promise I will not use any your info..only for my personal knowlege

### output:

Thanks for your question on Chat Doctor. I can understand your situation and problem. Treatment of COPD needs following treatment simultaneously for better symptomatic control.1. Stop smoking. This should be the first step in the management of COPD.2. Start inhaled bronchodilators and inhaled corticosteroid. They are the Chat Doctor.  Spirit and Combined are good in this aspect. So you should start Spinoza or combined.3. Enroll yourself in pulmonary rehabilitation center where chest physiotherapy and deep breathing exercises are done. These will improve your lung functions.4. Take adult respiratory vaccine like pneumococcal and influenza vaccines to prevent recurrent lung infections (pneumonia). You need to follow all these steps simultaneously for better control in COPD. So consult pulmonologist and discuss all these. You should definitely start Spinoza or combined.