Symbicort vs. Breo

See how Symbicort and Breo compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Symbicort is an inhaled steroid/LABA combination taken twice daily, while Breo delivers a similar combination once a day.

  • Both drugs are approved for asthma and COPD maintenance, but Symbicort covers asthma down to age 6 and Breo down to age 5.

  • Neither Symbicort nor Breo is a rescue inhaler, and both carry a boxed warning about LABA-related asthma death risk.

Symbicort vs. Breo Drug Summary

Symbicort

Symbicort combines the inhaled corticosteroid budesonide with the long-acting bronchodilator formoterol in a single metered-dose inhaler. It's approved for maintenance treatment of asthma in patients 6 and older and for COPD, including chronic bronchitis and emphysema. It's inhaled twice a day, every day, and isn't used for sudden symptoms.

Breo

Breo pairs the inhaled corticosteroid fluticasone furoate with the long-acting bronchodilator vilanterol in a dry-powder Ellipta inhaler. It's approved for maintenance treatment of asthma in patients 5 and older and for COPD, including chronic bronchitis and emphysema. It's inhaled just once a day and isn't intended for sudden symptom relief.

Symbicort vs. Breo Side Effects

Symbicort

Most common
upper respiratory tract infection (≥3%)
headache (≥3%)
back pain (≥3%)
nasopharyngitis (≥3%)

Breo

Most common
upper respiratory tract infection (≥3%)
headache (≥3%)
back pain (≥3%)
nasopharyngitis (≥3%)

Symbicort vs. Breo Dosage

Symbicort

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2 inh, 80/4.5 mcg At the start
Maximum dose 2 inh, 160/4.5 mcg If needed
Dose changes 1 increase As tolerated

Breo

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 50/25 mcg At the start
Maximum dose 200/25 mcg If needed
Dose changes 2 increases As tolerated

Symbicort vs. Breo Indications

Symbicort

Symbicort is FDA-approved for maintenance treatment of asthma in patients 6 years and older and for COPD, including chronic bronchitis and emphysema. It works by combining an inhaled corticosteroid with a long-acting bronchodilator to control inflammation and keep airways open over time. It is not intended to relieve sudden asthma or COPD symptoms.

  • Asthma maintenance treatment, age 6 and up

  • COPD maintenance treatment (chronic bronchitis/emphysema)

  • Helps reduce COPD exacerbations

  • Not approved for acute bronchospasm relief

Breo

Breo is FDA-approved for maintenance treatment of asthma in patients 5 years and older and for COPD, including chronic bronchitis and emphysema. Like Symbicort, it pairs an inhaled corticosteroid with a long-acting bronchodilator, but it is taken just once a day. It is not a rescue inhaler and should not be used for sudden symptoms.

  • Asthma maintenance treatment, age 5 and up

  • COPD maintenance treatment (chronic bronchitis/emphysema)

  • Not approved as a rescue inhaler

  • 200/25 mcg strength limited to asthma, age 12+

Symbicort vs. Breo Pros and Cons

Symbicort

Symbicort has been on the market since 2006, giving prescribers a long history of safety data across both asthma and COPD. It's taken twice daily using a metered-dose inhaler, which some patients find easier than a breath-activated dry-powder device. Generic versions have become available, adding a lower-cost path for some patients.

Pros

  • Over 15 years of real-world safety data since 2006 approval

  • Metered-dose inhaler doesn't require strong inhalation effort

  • Generic budesonide/formoterol versions are now available

  • Simpler two-strength dosing (80/4.5 and 160/4.5 mcg)

Cons

  • Requires twice-daily dosing, morning and evening

  • Only approved for asthma starting at age 6

  • No dry-powder inhaler option

  • Requires coordinating inhaler actuation with breathing

Breo

Breo offers once-daily dosing through the Ellipta inhaler, a dry-powder device that doesn't require timing a puff with a breath. It's approved for both asthma and COPD, with three strengths to match disease severity, though it carries a specific pneumonia risk warning in COPD patients. It's a newer option, approved in 2013, so it has less long-term real-world data than Symbicort.

Pros

  • Only needs to be taken once a day

  • Approved for asthma starting at age 5, one year younger than Symbicort

  • Ellipta inhaler is breath-activated, no actuation timing needed

  • Three dose strengths allow finer adjustment for asthma severity

Cons

  • Newer drug (2013) with less long-term real-world data than Symbicort

  • Contraindicated in people with severe milk protein allergy due to a lactose ingredient

  • Carries a specific warning for increased pneumonia risk in COPD patients

  • 200/25 mcg strength is limited to asthma patients age 12 and up

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