Breo vs. Pulmicort
See how Breo and Pulmicort compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Breo combines a steroid and long-acting bronchodilator in one once-daily inhaler, while Pulmicort is a steroid-only inhaler taken twice daily.
Breo is FDA-approved for both asthma and COPD, but Pulmicort is approved for asthma only.
Both drugs contain trace milk proteins from their lactose carrier and are contraindicated in patients with severe milk protein allergy.
Breo vs. Pulmicort Drug Summary
Breo
Breo is a once-daily inhaled combination of a corticosteroid (fluticasone furoate) and a long-acting bronchodilator (vilanterol), delivered through the Ellipta device. It is approved for maintenance treatment of both asthma in patients 5 and older and COPD, but it is not a rescue inhaler for sudden symptoms.
Pulmicort
Pulmicort (budesonide) is an inhaled corticosteroid alone, taken twice daily through the Flexhaler device, for long-term asthma control in patients 6 and older. It has no bronchodilator component, so it avoids the LABA boxed warning, but it is not approved for COPD.
Breo vs. Pulmicort Side Effects
Breo
Pulmicort
Breo vs. Pulmicort Dosage
Breo
Pulmicort
| STAGE | DOSE | WHEN |
| Starting dose | 50 mcg/25 mcg once daily | At the start |
| Maximum dose | 200 mcg/25 mcg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 180 mcg twice daily | At the start |
| Maximum dose | 720 mcg twice daily | If needed |
| Dose changes | 2 increases | As tolerated |
Breo
| STAGE | DOSE | WHEN |
| Starting dose | 50 mcg/25 mcg once daily | At the start |
| Maximum dose | 200 mcg/25 mcg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Pulmicort
| STAGE | DOSE | WHEN |
| Starting dose | 180 mcg twice daily | At the start |
| Maximum dose | 720 mcg twice daily | If needed |
| Dose changes | 2 increases | As tolerated |
Breo vs. Pulmicort Indications
Breo
Breo is approved for maintenance treatment of asthma in patients 5 and older and for COPD, including chronic bronchitis and emphysema. It is not intended for sudden symptom relief and always includes a long-acting bronchodilator alongside the steroid.
Maintenance therapy for asthma, ages 5 and up
Maintenance therapy for COPD, including chronic bronchitis and emphysema
Not a rescue inhaler for acute symptoms
200/25 mcg strength limited to asthma, ages 12 and up
Pulmicort
Pulmicort is approved for maintenance treatment of asthma as prophylactic therapy in patients 6 and older. It is sometimes used off-label to manage eosinophilic esophagitis, though that use is not FDA-approved.
Maintenance therapy for asthma, ages 6 and up
Off-label use for eosinophilic esophagitis (not FDA-approved)
Not for relief of acute bronchospasm
Approved for asthma only, not COPD
Breo vs. Pulmicort Pros and Cons
Breo
Breo combines an inhaled steroid with a long-acting bronchodilator in a single once-daily device, and it is the only fluticasone furoate/vilanterol combination approved for both asthma and COPD. Coverage varies by plan, but a manufacturer copay program can lower costs for eligible patients.
Pros
Only needs to be taken once a day, not twice
Approved for both asthma and COPD, giving broader use
Combines a steroid with a bronchodilator for added airway opening
Manufacturer copay program can meaningfully reduce the typical list price of roughly $225 to $550 a month for eligible patients
Cons
Carries a boxed warning for LABA-related asthma death risk
Not approved for children under age 5
Higher pneumonia risk specifically flagged in COPD patients
Includes a bronchodilator that some patients may not need
Pulmicort
Pulmicort delivers an inhaled steroid alone, twice daily, without a long-acting bronchodilator component. It is approved only for asthma, but it comes in a nebulized form for young children who cannot use a dry powder device.
Pros
Steroid-only formula avoids the LABA boxed warning
Available as nebulized Respules for children who can't use a dry powder inhaler
Used off-label for eosinophilic esophagitis, an added option beyond asthma
Longer FDA track record, approved since 2006
Cons
Requires twice-daily dosing instead of once a day
Not approved for COPD, only asthma
Risk of adrenal insufficiency when transferring from oral steroids
Higher rate of nasopharyngitis reported in trials than Breo
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