Breo vs. Advair: Which One Is Right for Me?

If you have asthma, you may have been prescribed a couple of different inhalers. These medications can help reduce daily asthma symptoms, preventing future asthma attacks, and preventing long-term lung damage.

With so many inhalers on the market, it can be confusing to know which one is best for you. We’ll compare two of the most common long-acting maintenance inhalers: Breo Ellipta (fluticasone/vilanterol) and Advair (fluticasone/salmeterol). Both of these inhalers help prevent asthma attacks and decrease daily symptoms.

What are Breo Ellipta and Advair?

Both Breo Ellipta and Advair are prescription inhalers that treat asthma. Breo Elipta and one type of Advair inhaler — Advair Diskus — are also approved for chronic obstructive pulmonary disease (COPD).

These inhalers are different from quick-relief (or rescue) inhalers, which kick in within minutes and are used as needed for asthma attacks. Breo Ellipta and Advair cannot be used to treat acute flare-ups of asthma or COPD. These long-acting maintenance inhalers are used daily, even if you have no symptoms.

Breo Ellipta and Advair are combination inhalers that contain two medications that work together to improve airflow:

1. An inhaled corticosteroid (ICS) to improve inflammation in the airway

2. A long-acting beta-agonist (LABA) to keep the airways relaxed and open

Both Breo Ellipta and Advair contain the corticosteroid fluticasone. The LABA in Breo Ellipta is vilanterol, and the LABA in Advair is salmeterol. Of note, there are other fluticasone/salmeterol inhalers available on the market, including AirDuo Digihaler and AirDuo Respiclick.

Breo Ellipta is approved to treat adults only. Advair Diskus is approved for both adults and children aged 4 years and older. Advair HFA is approved for adults and children who are at least 12 years old.

Breo Ellipta vs. Advair: Which is more effective?

The Global Initiative for Asthma guidelines consider Breo Ellipta and Advair to be similarly effective at treating moderate-to-severe asthma. And the Global Initiative for Chronic Obstructive Lung Disease guidelines also consider Breo Ellipta and Advair to be similarly effective at treating moderate-to-very severe COPD. In short, neither guideline recommends one inhaler over the other.

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Still, it’s good to examine the research when you’re comparing two medications. There have been a few randomized control trials (RCTs) — the best studies for identifying cause and effect — looking at Breo Ellipta versus Advair. One that included over 1,000 people with asthma found that Breo Ellipta and Advair were similarly effective at improving lung function. The study also found that the inhalers had similar side effects.

The available RCTs on Breo Ellipta versus Advair for COPD have shown that they’re similarly effective at treating the condition.

Breo Ellipta vs. Advair dosage

One important difference between the inhalers is that Breo Ellipta is a once-daily medication and Advair is used twice daily (12 hours apart). The type of fluticasone in Breo Ellipta (fluticasone furoate) is thought to last longer than the type of fluticasone in Advair (fluticasone propionate).

The medications also come in different doses:

• Breo Ellipta: 100 mcg or 200 mcg fluticasone furoate with 25 mcg vilanterol

• Advair Diskus: 100 mcg, 250 mcg, or 500 mcg fluticasone propionate with 50 mcg salmeterol

• Advair HFA: 45 mcg, 115 mcg, or 230 mcg fluticasone propionate with 21 mcg salmeterol

Another important difference between Breo Ellipta and Advair is that Advair comes in two forms:

• Dry powder inhaler (DPI): Advair Diskus and Breo Ellipta

• Metered dose inhaler (MDI): Advair HFA

Breo Ellipta only comes as a DPI. With DPIs, you inhale a dose of powdered medication into your lungs. The medication is released only when you take a deep, fast breath through the inhaler. This is different from an MDI, which pushes the medication into your lungs using an aerosol spray. With an MDI, you inhale the medication slowly over 3 to 5 seconds, then you hold your breath for 10 seconds if possible before exhaling.

What are the side effects of Breo Ellipta and Advair?

Because both Breo Ellipta and Advair contain a corticosteroid and a LABA, the side effects are similar. Common side effects of these inhalers include:

• Upper respiratory tract infections, such as the common cold

• Fungal infections of the mouth and throat, such as thrush

• Hoarseness and voice changes

• Headache

• Dizziness

Although rare, more serious side effects can also happen with Breo Ellipta and Advair, including:

• Increased potassium and blood sugar levels: Your healthcare provider may have you go for blood tests from time to time to monitor for these changes.

• More serious lung infections: This includes lower respiratory tract infections, like pneumonia.

• Greater risk for other infections: This is especially true if you have a weakened immune system.

• Heart problems: This could include blood pressure changes, a faster heart rate, or an abnormal heartbeat. If you have an existing heart problem, like an arrhythmia or high blood pressure (hypertension), let your healthcare provider know.

• Weaker bones in adults and slowed growth in children: These are possible side effects of oral corticosteroids. They’re probably less likely with inhaled corticosteroids, but your provider will still monitor for these changes.

• Eye problems: This could include glaucoma, cataracts, or dry eye. You may need regular eye exams while using one of these inhalers. If you develop any vision changes, let your provider know right away.

• Paradoxical bronchospasm: This unexpected tightening of the airways makes breathing difficult and requires immediate use of a rescue inhaler, like albuterol (ProAir HFA, Proventil HFA, Ventolin HFA). If you don’t have a rescue inhaler available, call 911 or go to your nearest emergency room.

Breo Ellipta and Advair medication interactions

Here is a list of common medications that may interact with Breo Ellipta or Advair:

• Beta blockers like metoprolol (Lopressor) and carvedilol (Coreg)

• Medications that can cause abnormal heart rhythm by prolonging the “QT interval,” including tricyclic antidepressants and monoamine oxidase inhibitors

• Diuretics like loop diuretics and thiazides

• Some antifungals, like ketoconazole

• Some HIV medications, like those containing ritonavir (Norvir) or atazanavir (Reyataz)

This list is not comprehensive. Talk with your healthcare provider and pharmacist before starting treatment with an inhaler. They can help you check for medication interactions and adjust the doses of your other medications if needed. But you may only need more frequent monitoring with blood tests.

Keep in mind: DPIs like Breo Ellipta and Advair Diskus may contain lactose, a sugar found in cow’s milk. So people with a severe milk protein allergy should avoid these inhalers. Advair HFA doesn’t contain lactose, so it may be a good alternative.

How to save

There are many ways to save on the brand-name and generic versions of Breo Ellipta and Advair.

Breo Ellipta

GoodRx may be able to help you save over 60% off the average retail price of the generic version of Breo Ellipta. Generic Breo Ellipta’s price at certain pharmacies may be as low as $233.52 with a free GoodRx coupon.

You can also save on brand-name Breo Ellipta through patient assistance programs. If you’re uninsured or have Medicare, you may be eligible for Breo Ellipta’s patient assistance program, which offers the medication free of cost.

Advair

GoodRx may be able to help you save over 70% off the average retail price of the two generic versions of Advair Diskus. Fluticasone/salmeterol’s price at certain pharmacies may be as low as $56.66 with a free GoodRx coupon. Wixela Inhub's price may be as low as $56.66 with a free GoodRx coupon.

You can also save on brand-name Advair Diskus or Advair HFA through patient assistance programs. If you’re uninsured or have Medicare, you may be eligible for Advair’s patient assistance program, which offers the medication free of cost.

What are some alternatives to Breo Ellipta and Advair?

As mentioned, Breo Ellipta and Advair contain a corticosteroid and a LABA. Some alternatives to Breo Ellipta and Advair that also contain these two types of medications include:

• Symbicort (Budesonide/formoterol)

• Dulera (Mometasone/formoterol)

Symbicort is available as a generic medication (Breyna), but Dulera is brand-name only. They’re both MDIs that are used twice daily (like Advair HFA). Generic Symbicort might be a good alternative to brand-name Advair HFA if you want a lower-cost MDI. But you can also use GoodRx to access Dulera at an exclusive cash price of $199.

Fluticasone (Flovent Diskus, Flovent HFA) and salmeterol (Serevent Diskus) are also available on their own as single-medication inhalers. But using two inhalers is likely more expensive than using a combination inhaler.

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Written by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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