Battle of the Asthma Inhalers

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Asthma sufferers not only deal with a chronic problem but the high cost as well. When it comes to asthma there are quick-relief inhalers and long-term controller inhalers. Once your doctor has decided you need a long-term control inhaler (not just your albuterol inhaler), you will be faced with a choice of three. All three are expensive but which one is right for you?

Long acting bronchodilators (LABAs) mixed with an inhaled steroid have become the mainstay of asthma treatment for those with moderate asthma symptoms. These are long-term meds that reduce inflammation in the airways.

Why do we put a long acting bronchodilator (LABA) with a steroid in one inhaler? It’s more convenient, though more expensive. More importantly, steroid/LABA inhalers are safer for you and more effective. The addition of a LABA to your steroid inhaler makes it so you don’t have to increase the dose of steroid. The use of LABAs WITHOUT steroid inhalers is not as safe. Each of the LABA/steroid combination inhalers is available in different strengths.

So what are your choices?

1. Symbicort (budesonide and formoterol). This combination may stand out only because it has also been shown to be useful as a reliever medication (not just maintenance) in persistent asthma.

2. Dulera (mometasone and formoterol)

3. Advair Diskus or Advair HFA (fluticasone and salmeterol).

All are essentially created equally, and all are effective. The bad news is that all are also expensive, so find out which one is covered by your insurance and ask about starting on that. The good news is that the patents for Advair are set to expire in the next year or so, making a generic possible, but nobody is lining up to make the generic version. So don’t hold your breath on that yet.

Dr O.

Symbicort, Dulera, Advair Diskus and Advair HFA all range from around $200 – $300 per inhaler, depending on strength. Most insurance plans will cover the inhalers as Tier 2 medications, meaning a moderate copay, though they are considered Tier 3 or not covered by some plans. Each inhaler also has a manufacturer discount available, for reducing copays, a small cash discount, or free trials.

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