Breo vs. Spiriva
See how Breo and Spiriva compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Breo pairs a steroid with a long-acting bronchodilator, while Spiriva works alone as a long-acting anticholinergic, so the two control airways through different mechanisms.
Both are once-daily maintenance inhalers for COPD, but only Breo and Spiriva's Respimat version are approved for asthma, and neither replaces a rescue inhaler.
Breo carries a boxed warning about LABA-related asthma death risk, while Spiriva's most common side effects come from its anticholinergic action, like dry mouth and constipation.
Breo vs. Spiriva Drug Summary
Breo
Breo is a combination inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) used for daily maintenance treatment of asthma and COPD. It delivers fluticasone furoate and vilanterol together through a single once-daily inhaler. Breo is not a rescue medication and will not relieve sudden breathing problems.
Spiriva
Spiriva is a long-acting muscarinic antagonist (LAMA) used for daily maintenance treatment of COPD, and for asthma when given through the Respimat device. It delivers the anticholinergic tiotropium bromide once daily via the HandiHaler or Respimat inhaler. Like Breo, it is not intended for rescue use during an asthma or COPD attack.
Breo vs. Spiriva Side Effects
Breo
Spiriva
Breo vs. Spiriva Dosage
Breo
Spiriva
| 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 | 2.5 mcg once daily | At the start |
| Maximum dose | 18 mcg once 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 |
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 |
Breo vs. Spiriva Indications
Breo
Breo is approved for maintenance treatment of COPD, including chronic bronchitis and emphysema, and for asthma in patients 5 years and older. It combines an inhaled steroid with a long-acting bronchodilator to reduce airway inflammation and keep airways open. It is taken once a day and is not meant for sudden flare-ups.
Maintenance treatment of COPD, including chronic bronchitis and emphysema
Maintenance treatment of asthma, ages 5 and up
Available in three strengths for different ages and conditions
Not approved for acute bronchospasm or rescue use
Spiriva
Spiriva is approved for long-term maintenance treatment of COPD, including chronic bronchitis and emphysema, and to reduce COPD exacerbations. The Respimat device is also approved for asthma maintenance in patients 6 years and older. It is taken once a day and, like Breo, is not meant for sudden symptoms.
Maintenance treatment of COPD, including chronic bronchitis and emphysema
Reduces the frequency of COPD exacerbations
Respimat device approved for asthma maintenance, ages 6 and up
HandiHaler device approved for COPD only, in adults
Breo vs. Spiriva Pros and Cons
Breo
Breo is the only fluticasone furoate/vilanterol combination approved for once-daily use in both asthma and COPD, offering steroid control and bronchodilation in one inhaler. It comes in three strengths, letting doctors match dose to age and disease severity. Its lactose component and LABA boxed warning are worth discussing with a prescriber.
Pros
Only ICS/LABA combo approved for once-daily dosing in both asthma and COPD
Three strengths allow dosing tailored to age and disease severity
Manufacturer copay program can lower cost to $0 to $35 a month for eligible patients
Roughly $225 to $550 a month without insurance, before savings programs, versus $600 to $630 for Spiriva
Cons
Boxed warning for LABA-related risk of asthma death
Contraindicated in people with severe milk protein allergy due to lactose
Carries an increased risk of pneumonia in COPD patients
Not approved for children under 5 years old
Spiriva
Spiriva has been on the market for over two decades, giving prescribers a long track record of real-world safety data. It works through a different mechanism than steroid-based inhalers, avoiding some steroid-related risks, and comes in two devices to fit different needs. Its anticholinergic action brings its own set of side effects to weigh.
Pros
Over two decades of clinical use and real-world safety data
Two device options, HandiHaler and Respimat, for different needs
Anticholinergic mechanism avoids steroid-related side effects
No boxed warning for asthma-related death risk
Cons
May worsen narrow-angle glaucoma or urinary retention
Common anticholinergic side effects like dry mouth and constipation
Roughly $600 to $630 a month without insurance, before savings programs, versus $225 to $550 for Breo
HandiHaler version is not approved for asthma
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