I truely understand the concept of how the receptors in the lung are saturated with Spiriva , and therefore atrovent is ineffective. I had a Pulmonoligist specifically order Spiriva and Atrovent together. Either He does not understand the concept of Both meds being similar in structure, or there is another benefit ? Is anyone familiar or has ran across this scenerio ? If so please tell me the benefit, if one drug blocks the receptors and is already on board for 24 hrs, and atrovent a 6hr med is trying to block the already blocked receptors , how is this effective?