My mom is in hospital with type a flu and pneumonia. She has regular albuterol breathing treatments at home. At one point when I didn t think just albuterol was being esffective , we tried the duo. She did not respond well so we went back to only albuterol. Here at the hospital they were giving her duo and I wasn t aware....she was already having difficulty with a fib....after the third treatment I asked what they were giving her...she had a purple face, jerking and a person from cardiac came to her rooom because her heart rate was overhead 180 and a very elevated by. Respiratory was arguing with me that it was the albuterol in the duo and I assured them that she has it at home everyday and does not shake. Also a doctor told me that there was no difference in metoprolol and traprock... when over the years anytime it s not topol she gets sick as a dog,