I have COPD & use albuterol for rescue inhaler & Spiriva. I also use a nebulizer 3 x a day & cpap when I sleep (I have COPD /sleep apnea combo) . I do okay with this med/inhaler combo but I hear ya on the steroids making you manic. This combo doesn't make me manic but it's different for everybody. Hope you find the right combo soon!!! I'll keep you in my thoughts!