Hi Pat, Thank you for your question. This is a matter you really need to discuss with your doctor. There are several strengths of Asmanex available, and if the dose you're currently taking isn't relieving your symptoms, you may need a higher dose or another medication. Asmanex is an inhaled steroid, and steroids are known to cause thinning of the skin. If you are experiencing this side effect, you should bring it to the attention of your doctor. Spiriva is an anticholinergic agent, and it is only to be used once daily. Spiriva is only FDA approved for use in COPD (chronic obstructive pulmonary disease), not for use in asthma. As I mentioned before, if the combination of Spiriva and Asmanex is not controlling your symptoms, you need to discuss with your doctor what other options are available. Best of luck, Casey