Breo vs. Xopenex
See how Breo and Xopenex compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Breo is a once-daily maintenance inhaler for asthma and COPD and is not meant to treat sudden breathing problems.
Xopenex is a fast-acting bronchodilator used to treat or prevent bronchospasm and is not a long-term controller medicine.
Because they work differently, many patients use Breo for daily control and a short-acting inhaler like Xopenex for quick relief.
Breo vs. Xopenex Drug Summary
Breo
Breo is an inhaled corticosteroid and long-acting bronchodilator combination used for daily maintenance of asthma and COPD. It comes in a once-daily Ellipta inhaler available in three dose strengths. Breo does not treat sudden asthma attacks or COPD flare-ups.
Xopenex
Xopenex is a short-acting bronchodilator that relaxes airway muscles to relieve or prevent bronchospasm. It comes as a nebulizer solution or an HFA inhaler, taken several times a day as needed. Xopenex works within minutes but does not control airway inflammation long-term.
Breo vs. Xopenex Side Effects
Breo
Xopenex
Breo vs. Xopenex Dosage
Breo
Xopenex
| 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 | 0.31 mg three times daily | At the start |
| Maximum dose | 90 mcg (2 inhalations) q4-6h | If needed |
| Dose changes | 4 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 |
Xopenex
| STAGE | DOSE | WHEN |
| Starting dose | 0.31 mg three times daily | At the start |
| Maximum dose | 90 mcg (2 inhalations) q4-6h | If needed |
| Dose changes | 4 increases | As tolerated |
Breo vs. Xopenex Indications
Breo
Breo is FDA-approved for daily maintenance treatment of asthma in patients 5 years and older and for COPD, including chronic bronchitis and emphysema. It combines an inhaled steroid that reduces airway inflammation with a long-acting bronchodilator that keeps airways open. It is not intended for immediate relief of breathing difficulty.
Maintenance treatment of asthma in patients 5+
Maintenance treatment of COPD, including bronchitis and emphysema
Reduces asthma and COPD flare-ups over time
Not for acute asthma attacks or COPD exacerbations
Xopenex
Xopenex is FDA-approved to treat or prevent bronchospasm in people with reversible obstructive airway disease such as asthma. It relaxes the muscles around the airways within minutes, making it useful for quick symptom relief. It does not treat the underlying inflammation that causes asthma or COPD.
Treats acute bronchospasm episodes
Prevents bronchospasm before triggers like exercise
Used in asthma and other reversible airway diseases
Not a substitute for an inhaled corticosteroid
Breo vs. Xopenex Pros and Cons
Breo
Breo offers simple once-daily dosing, which can improve adherence compared with multiple-times-daily inhalers. As a controller medicine, it works over time to reduce airway inflammation rather than provide quick relief, so it carries an FDA boxed warning about LABA-related asthma risk. Insurance coverage for combination ICS/LABA inhalers varies by plan.
Pros
Only needs to be taken once a day
Available in three strengths for different ages and severities
Treats both asthma and COPD with one inhaler
Manufacturer copay program can meaningfully lower monthly out-of-pocket cost for eligible patients
Cons
Carries a boxed warning about LABA-related asthma death risk
Not for sudden breathing problems, so a rescue inhaler is still needed
Roughly $225 to $550 per month without insurance, before savings programs
Contains lactose, so not for those with severe milk protein allergy
Xopenex
Xopenex provides fast bronchodilation for people who need quick relief or pretreatment before a trigger like exercise. It must be used multiple times a day and does not address airway inflammation, so it is often paired with a daily controller medicine. It has a lower monthly cost than many maintenance inhalers.
Pros
Works within minutes to relieve sudden symptoms
Available as both nebulizer solution and HFA inhaler
Can be used before exercise to prevent bronchospasm
Roughly $55 to $120 per month without insurance, before savings programs
Cons
Must be used several times a day, not once daily
Does not reduce airway inflammation over time
Excessive use can be dangerous and may mask worsening disease
Not approved for long-term asthma or COPD control
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