Differences and Similarities Between Airsupra, Wixela, and Spiriva
Medication Classifications and Components
Airsupra contains fluticasone furoate (ICS) and vilanterol (LABA), Wixela contains fluticasone propionate (ICS) and salmeterol (LABA), while Spiriva contains tiotropium (LAMA) - these are fundamentally different medication classes that can be safely combined. 1, 2
Key Differences:
Airsupra is a once-daily ICS/LABA combination containing fluticasone furoate 100-200 mcg and vilanterol 25 mcg, approved for both COPD maintenance and asthma in patients ≥5 years 1
Wixela is a twice-daily ICS/LABA combination containing fluticasone propionate and salmeterol (generic equivalent to Advair Diskus), bioequivalent for asthma and COPD treatment 2, 3
Spiriva is a once-daily LAMA (tiotropium) that provides sustained bronchodilation through anticholinergic mechanisms, superior to LABAs for exacerbation prevention 4, 5
Key Similarities:
- All three are long-acting maintenance medications requiring scheduled daily use, not for acute symptom relief 6, 7
- All improve lung function, dyspnea, and health status in COPD patients 4
- All require proper inhaler technique and regular adherence for optimal efficacy 6
Can They Be Used Together?
Yes, Spiriva (LAMA) can and should be combined with either Airsupra or Wixela (ICS/LABA combinations) in appropriate patients, but never use Airsupra and Wixela together as they contain overlapping medication classes. 4, 5
Safe Combinations:
Spiriva + Wixela (or Airsupra) creates triple therapy (LAMA/LABA/ICS), which is strongly recommended for COPD patients with moderate-to-high symptom burden (CAT ≥10, mMRC ≥2) and FEV1 <80% predicted who remain symptomatic on dual therapy 4
Triple therapy (LAMA/LABA/ICS) significantly improves dyspnea, exercise tolerance, and health status compared to LAMA/LABA or ICS/LABA dual therapy alone 4
Adding tiotropium to fluticasone/salmeterol improved trough FEV1 by 186 mL versus 140 mL with ICS/LABA alone, reduced COPD hospitalizations (incidence rate ratio 0.53), and improved quality of life 8, 9
Unsafe Combinations:
Never combine Airsupra with Wixela - this would provide two LABAs (vilanterol + salmeterol) and two ICS formulations simultaneously, increasing adverse effects without additional benefit 5
Using multiple medications from the same pharmacological class provides no additional benefit but increases risk of class-specific adverse effects 5
Clinical Decision Algorithm
For COPD Patients:
Step 1: If low exacerbation risk with moderate-high symptoms (CAT ≥10):
- Start LAMA/LABA dual therapy (Spiriva + a LABA, or use a combination product) 4
Step 2: If high exacerbation risk (≥2 moderate or ≥1 severe exacerbation/year) OR persistent symptoms despite dual therapy:
- Escalate to triple therapy: Spiriva + Wixela (or Airsupra) 4, 7
- Triple therapy reduces mortality (OR 0.70,95% CI 0.54-0.90) in high-risk patients 5
Step 3: If already on ICS/LABA (Wixela or Airsupra) with inadequate control:
For Asthma Patients:
- ICS/LABA combinations (Wixela or Airsupra) are preferred over LAMA/LABA for patients with concomitant asthma and COPD 4
- Spiriva can be added if asthma symptoms remain uncontrolled on ICS/LABA therapy 1
Important Safety Considerations
Pneumonia Risk:
- ICS-containing regimens (Wixela, Airsupra) increase pneumonia risk, especially in patients who smoke, are ≥55 years, have BMI <25 kg/m², or have severe airflow limitation 4
- Monitor for signs/symptoms of pneumonia when using triple therapy 4
Anticholinergic Effects:
- Spiriva may cause dry mouth, urinary retention, and constipation - monitor elderly patients closely 5
Dosing Schedule:
- Wixela: Twice daily (morning and evening) 2, 3
- Airsupra: Once daily 1, 10
- Spiriva: Once daily 6, 8
- All require scheduled use, not PRN - short-acting bronchodilators (albuterol) should accompany all regimens for acute symptom relief 6, 7
Common Pitfall:
- Never use long-acting bronchodilators (Airsupra, Wixela, Spiriva) as rescue medications - they require consistent daily use to maintain therapeutic levels and prevent exacerbations 6