Long-Acting Maintenance Asthma Inhalers: Know Your Options

If you have asthma, you probably use a maintenance inhaler to manage your symptoms over time. But with so many types and brands available, it can be hard to know which one is right for you. These include inhaled corticosteroids (ICS), long-acting beta agonists (LABAs), long-acting muscarinic antagonists (LAMAs), and various combinations of these — each with their own benefits and side effects.

Below, we’ll provide a high-level summary of the top long-acting asthma inhaler brands to help you better understand your options. While there are generic versions for many of these, we’ll mostly focus on the brand-name products.

Inhaled corticosteroid inhaler brands

Inhaled corticosteroids are often a first-choice treatment for long-term asthma management. They work by lowering airway inflammation, helping you breathe easier. If used every day, they lower the number and severity of asthma attacks.

Here's a list of brand-name ICS inhalers:

• Alvesco (ciclesonide)

• Arnuity Ellipta (fluticasone)

• Asmanex HFA (mometasone)

• Asmanex Twisthaler (mometasone)

• Pulmicort Flexhaler (budesonide)

• Qvar RediHaler (beclomethasone)

Common ICS side effects

Inhaled corticosteroids are generally well-tolerated. When side effects do occur, they aren’t generally serious. But they can include:

• Voice changes

• A hoarse voice

• Oral thrush (yeast infections in the mouth or throat)

• Cough

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Your prescriber and pharmacist will likely recommend rinsing your mouth after using a corticosteroid-containing inhaler. This is an easy way to lower your risk of developing oral thrush.

Long-acting beta agonist inhaler brands

LABAs work by relaxing the airways in the lungs to help you breathe easier. They’re used to prevent asthma attacks, manage asthma symptoms, and improve lung function.

While there are several LABA inhaler and nebulizer brands, Serevent Diskus (salmeterol) is a LABA inhaler used for asthma specifically.

People with asthma generally shouldn’t use a LABA inhaler by itself, though. That’s because there’s a higher risk of serious side effects. If you need a LABA, your healthcare professional will likely prescribe a combination inhaler that contains an ICS and a LABA.

Common LABA side effects

Typical LABA side effects include:

• Muscle cramps or spasms

• Tremors

• Heart palpitations

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Long-acting muscarinic antagonist inhaler brands

Similar to LABAs, LAMAs relax the muscles of the airways to help manage asthma symptoms. LAMAs are another option if you need additional breathing support beyond an ICS and LABA.

Spiriva Respimat (tiotropium) is the main stand-alone LAMA asthma inhaler. Spiriva HandiHaler, a similar inhaler, is only FDA approved for chronic obstructive pulmonary disease (COPD) — not asthma.

Common LAMA side effects

Possible LAMA side effects include:

• Dry mouth

• Trouble urinating

• Metallic taste in mouth

• Widening of the pupils

Combination maintenance inhalers

Combination inhalers for asthma contain two or three active ingredients. This could include an ICS and a LABA, or all three types of inhaled medications for asthma: an ICS, LABA, and LAMA.

These asthma inhalers combine multiple medications into one inhaler:

• Advair Diskus (fluticasone / salmeterol)

• Advair HFA (fluticasone / salmeterol)

• AirDuo RespiClick (fluticasone / salmeterol)

• Wixela Inhub (fluticasone / salmeterol)

• Breo Ellipta (fluticasone / vilanterol)

• Dulera (mometasone / formoterol)

• Symbicort (budesonide / formoterol)

• Breyna (budesonide / formoterol)

• Trelegy Ellipta (fluticasone / umeclidinium / vilanterol)

The ICS components of these products decrease inflammation in the lungs, while the LABAs and LAMAs are bronchodilators that relax the airways.

Combination inhalers tend to be more convenient and possibly less expensive; this is because you need only one inhaler to get multiple lung medications, rather than two or more inhalers.

Common combination inhaler side effects

Combination inhaler side effects vary based on the types of medications in the inhaler. For example:

• An inhaler that contains an ICS could cause side effects such as voice changes or oral thrush.

• An inhaler that contains a LABA could cause side effects like tremors and a fast heartbeat.

• An inhaler that contains a LAMA could cause side effects that include dry mouth and metallic taste.

For any inhaler that you use — no matter if it’s a stand-alone inhaler or a combination inhaler — know that side effects vary by product. For a more specific list of side effects to expect, make sure to read the labeling that comes with your inhaler. You can also ask your pharmacist for guidance.

Which asthma inhaler brand is best for you?

The best asthma inhaler for you depends on how severe your asthma is and what your symptoms are. Your healthcare professional should conduct breathing tests and ask you questions to figure out how well your lungs are working. Generally, there’s not a preference of one product over another for inhalers within the same medication class. In some cases, though, your insurance coverage may push you in a specific direction.

Inhaled corticosteroids are traditional first-choice, long-acting maintenance inhalers for asthma. They’re usually the first type of maintenance inhaler that’s prescribed for mild-to-moderate asthma symptoms. If your current dose isn’t working as well as you think it should, you can speak to your prescriber about raising your dose.

If an ICS alone doesn’t manage your asthma symptoms, the next step may be to add a LABA. This is often done by switching to a combination inhaler that has an inhaled corticosteroid and a LABA, such as Advair. Switching to a combination inhaler helps limit the number of inhalers you have to carry around and pay for.

If you need even more breathing support, your healthcare professional may also prescribe a LAMA. This could be a separate inhaler or part of a triple-combination inhaler, like Trelegy Ellipta.

Since everyone’s symptoms are different, make sure to check with your healthcare professional about what treatment may be best for you.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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