Advair vs. Spiriva
See how Advair and Spiriva compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Advair combines an inhaled steroid with a long-acting bronchodilator in one inhaler taken twice daily, while Spiriva is a bronchodilator alone taken once daily.
Both drugs are long-term maintenance treatments only and are not meant to relieve sudden asthma or COPD flare-ups.
Spiriva's Respimat device is approved for asthma starting at age 6, but its HandiHaler device is approved for COPD in adults only.
Advair vs. Spiriva Drug Summary
Advair
Advair is a combination inhaler containing an inhaled corticosteroid (fluticasone) and a long-acting beta-agonist (salmeterol), used for long-term control of asthma and COPD. It is inhaled twice daily using a Diskus device and works by reducing airway inflammation while relaxing airway muscles.
Spiriva
Spiriva is a long-acting muscarinic antagonist (LAMA) that relaxes airway muscles to keep airways open in COPD and, with the Respimat device, in asthma. It is inhaled once daily using either the HandiHaler or Respimat device and does not contain a steroid.
Advair vs. Spiriva Side Effects
Advair
Spiriva
Advair vs. Spiriva Dosage
Advair
Spiriva
| STAGE | DOSE | WHEN |
| Starting dose | 100 mcg/50 mcg twice daily | At the start |
| Maximum dose | 500 mcg/50 mcg twice daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 2.5 mcg once daily | At the start |
| Maximum dose | 18 mcg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Advair
| STAGE | DOSE | WHEN |
| Starting dose | 100 mcg/50 mcg twice daily | At the start |
| Maximum dose | 500 mcg/50 mcg twice daily | If needed |
| Dose changes | 2 increases | As tolerated |
Spiriva
| STAGE | DOSE | WHEN |
| Starting dose | 2.5 mcg once daily | At the start |
| Maximum dose | 18 mcg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Advair vs. Spiriva Indications
Advair
Advair is FDA-approved for long-term asthma control in people 4 and older and for maintenance treatment of COPD, including reducing exacerbations. It combines steroid and bronchodilator action in one inhaler, so it is not meant for sudden breathing attacks.
Maintenance asthma treatment (ages 4+)
Maintenance COPD airflow obstruction treatment
Reduces COPD exacerbations in at-risk patients
Not for acute asthma or COPD attacks
Spiriva
Spiriva is FDA-approved for long-term maintenance of COPD, including chronic bronchitis and emphysema, and for reducing COPD exacerbations. Delivered via Respimat, it is also approved for asthma maintenance in patients 6 and older, but it is not a rescue medication.
Maintenance COPD bronchospasm treatment
Reduces COPD exacerbations in at-risk patients
Asthma maintenance ages 6+ (Respimat only)
Not for acute asthma or COPD attacks
Advair vs. Spiriva Pros and Cons
Advair
Advair pairs an inhaled steroid with a bronchodilator in one device, treating both airway inflammation and muscle tightening for asthma and COPD. A generic version, Wixela Inhub, is available and can lower out-of-pocket costs compared with brand-name inhalers.
Pros
Treats inflammation and bronchospasm in one inhaler
Approved for asthma starting at age 4
Generic version (Wixela) available at lower cost
Typically $300 to $500 per month before insurance, versus $600 to $630 for Spiriva
Cons
Requires twice-daily dosing
Contains a steroid, which can cause thrush or hoarseness
Contraindicated in severe milk protein allergy
Spiriva
Spiriva is a bronchodilator alone, without an inhaled steroid, so its side effects center on anticholinergic effects rather than steroid-related ones. It has one of the longest track records among LAMA inhalers, with over two decades of clinical use.
Pros
Once-daily dosing
No inhaled steroid, so no thrush or hoarseness risk
Two device options: HandiHaler and Respimat
Long clinical track record of over 20 years
Cons
Typically $600 to $630 per month before insurance, versus $300 to $500 for Advair
Can worsen narrow-angle glaucoma or urinary retention
HandiHaler device is approved for COPD only, not asthma
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