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

Most common
nasopharyngitis (≥3%)
headache (≥3%)
oral candidiasis (≥3%)
back pain (≥3%)

Xopenex

Most common
bronchitis (≥2%)
dizziness (≥2%)
pain (≥2%)
pharyngitis (≥2%)

Breo vs. Xopenex 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

Xopenex

Dosage
Dosage Table
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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