I am new and looking for advice for my 85 year family member who lives in Vermont. She has COPD and asthma. She is taking Spiriva and Symbacort. She is living at home and her quality of life has significantly declined in the last 6 months, she was previously very active. She can't walk across the room without losing her breath. She is on oxygen at night. There is a doctor shortage in Vermont and she only sees her pulmonary doctor once a year. Is this the normal progression of the disease or can other treatments help.