What are the alternatives to Advair (fluticasone-salmeterol) and Breztri (budesonide-glycopyrrolate-formoterol)?

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Last updated: April 15, 2025 • View editorial policy

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From the Guidelines

Alternatives to Advair and Breztri include Symbicort (budesonide/formoterol) and Dulera (mometasone/formoterol) for asthma, and Trelegy Ellipta (fluticasone/umeclidinium/vilanterol) for COPD. The choice of alternative medication depends on the specific condition, symptom severity, and individual response of the patient. According to the guidelines for the diagnosis and management of asthma 1, inhaled corticosteroids (ICSs) are the most effective long-term control medications for persistent asthma, and they should be used in combination with long-acting beta-agonists (LABAs) for moderate or severe persistent asthma. Some key points to consider when choosing an alternative to Advair and Breztri include:

  • The patient's age and severity of asthma or COPD
  • The presence of any allergies or other medical conditions
  • The patient's response to previous treatments
  • The potential side effects of the medication, such as oral thrush, hoarseness, and increased heart rate
  • The importance of using a spacer with metered-dose inhalers and rinsing the mouth after use to prevent thrush The guidelines also recommend that LABAs should only be used in combination with ICSs, and not as monotherapy for long-term control of asthma 1. It is essential to discuss the alternatives with a healthcare provider to determine the best option for the patient's specific condition and needs.

From the Research

Alternatives to Advair and Breztri

Alternatives to Advair and Breztri include other combination inhalers that contain an inhaled corticosteroid (ICS) and a long-acting beta2-agonist (LABA), such as:

  • Budesonide/formoterol (Symbicort) 2, 3, 4
  • Fluticasone/salmeterol (Advair) is being compared to budesonide/formoterol in some studies, but budesonide/formoterol has been shown to be more effective in preventing exacerbations in chronic obstructive pulmonary disease (COPD) 5
  • Budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) is a triple therapy that has been shown to be effective in patients with COPD and phenotypic features of asthma 6

Key Findings

  • Budesonide/formoterol has been shown to be more effective than fluticasone/salmeterol in preventing exacerbations in COPD 5
  • Budesonide/formoterol maintenance and reliever therapy has been shown to reduce severe exacerbations and maintain daily asthma control at a lower overall steroid load compared to traditional combination therapies 4
  • Budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) has been shown to improve lung function, reduce exacerbations, and improve health-related quality of life in patients with COPD and phenotypic features of asthma 6

Comparison of Treatments

  • Budesonide/formoterol has been compared to fluticasone/salmeterol in several studies, with budesonide/formoterol showing greater efficacy in preventing exacerbations in COPD 5
  • Budesonide/formoterol maintenance and reliever therapy has been compared to traditional combination therapies, with similar daily asthma control achieved at a lower overall steroid load 4
  • Budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) has been compared to dual therapies, with BGF showing improved lung function, reduced exacerbations, and improved health-related quality of life in patients with COPD and phenotypic features of asthma 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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