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

Most common
URI (up to 21%)
Headache (up to 12%)
Oral candidiasis (up to 5%)
Throat irritation (up to 3%)

Spiriva

Most common
Pharyngitis (up to 12.5%)
Sinusitis (up to 6.5%)
Headache (up to 5.7%)
Constipation (up to 5.1%)

Advair vs. Spiriva Dosage

Advair

Dosage
Dosage Table
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

Dosage
Dosage Table
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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