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

Most common
Nasopharyngitis (≥3%)
Headache (≥3%)
Oral candidiasis (≥3%)
Back pain (≥3%)

Pulmicort

Most common
Nasopharyngitis (up to 9.3%)
Nasal congestion (up to 2.7%)
Pharyngitis (up to 2.7%)
Rhinitis allergic (up to 2.2%)

Breo vs. Pulmicort Dosage

Breo

Dosage
Dosage Table
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

Dosage
Dosage Table
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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