Symbicort vs. Spiriva
See how Symbicort and Spiriva compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Symbicort combines a steroid and long-acting bronchodilator in one twice-daily inhaler, while Spiriva is a once-daily long-acting anticholinergic bronchodilator alone.
Neither Symbicort nor Spiriva is a rescue inhaler, so both require a separate fast-acting medication for sudden breathing symptoms.
Symbicort is approved down to age 6 for asthma, while Spiriva's asthma approval at age 6 and up applies only to its Respimat device.
Symbicort vs. Spiriva Drug Summary
Symbicort
Symbicort is an inhaled corticosteroid and long-acting beta2-agonist (ICS/LABA) combination used for maintenance treatment of asthma in patients 6 and older and for COPD, including chronic bronchitis and emphysema. It comes as a metered-dose inhaler taken twice daily and is not meant for sudden symptom relief.
Spiriva
Spiriva is a long-acting muscarinic antagonist (LAMA) bronchodilator used for maintenance treatment of COPD, including chronic bronchitis and emphysema, and for asthma in patients 6 and older when using the Respimat device. It is inhaled once daily through either the HandiHaler capsule device or the Respimat spray inhaler.
Symbicort vs. Spiriva Side Effects
Symbicort
Spiriva
Symbicort vs. Spiriva Dosage
Symbicort
Spiriva
| STAGE | DOSE | WHEN |
| Starting dose | 2 inh 80/4.5 mcg twice daily | At the start |
| Maximum dose | 2 inh 160/4.5 mcg twice daily | If needed |
| Dose changes | 1 increase | 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 |
Symbicort
| STAGE | DOSE | WHEN |
| Starting dose | 2 inh 80/4.5 mcg twice daily | At the start |
| Maximum dose | 2 inh 160/4.5 mcg twice daily | If needed |
| Dose changes | 1 increase | 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 |
Symbicort vs. Spiriva Indications
Symbicort
Symbicort is FDA-approved for maintenance treatment of asthma in patients 6 years and older and for maintaining airflow and reducing exacerbations in COPD. It is not approved for relief of sudden bronchospasm and should always be paired with a rescue inhaler.
Maintenance treatment of asthma in patients 6 and older
Maintenance treatment of COPD airflow obstruction
Reduces exacerbations in COPD patients
Not approved for relief of sudden bronchospasm
Spiriva
Spiriva is FDA-approved for long-term maintenance treatment of COPD-related bronchospasm and for reducing COPD exacerbations, using either the HandiHaler or Respimat device. The Respimat version is also approved for asthma maintenance in patients 6 and older.
Long-term maintenance treatment of COPD bronchospasm
Reduces COPD exacerbations
Asthma maintenance in patients 6+ (Respimat only)
Not approved for acute bronchospasm relief
Symbicort vs. Spiriva Pros and Cons
Symbicort
Symbicort pairs an inhaled steroid with a long-acting bronchodilator, which comes with a boxed warning for LABA-related asthma risk but also brings broad pediatric asthma approval. It's typically the less expensive of the two options.
Pros
Combines an anti-inflammatory steroid with a bronchodilator in one inhaler
FDA-approved for asthma maintenance in children as young as 6
Long track record of pediatric and adult asthma use since 2006
Typically costs less than Spiriva, roughly $300 to $500 monthly versus $600 to $630
Cons
Carries a boxed warning for increased risk of asthma-related death from the LABA component
Requires twice-daily dosing rather than once-daily
Only available as a single metered-dose inhaler, unlike Spiriva's two device options
Steroid component may raise risk of infections like sinusitis or nasopharyngitis
Spiriva
Spiriva works purely as a long-acting anticholinergic bronchodilator, without the steroid-related warnings that come with Symbicort. It offers once-daily dosing and device flexibility, but typically costs more per month.
Pros
Once-daily dosing, simpler routine than twice-daily inhalers
Available in two devices, HandiHaler and Respimat, tailored to different needs
Decades of long-term safety data as one of the earliest LAMA bronchodilators
Not an inhaled corticosteroid, so no added steroid-related infection risk
Cons
Typically costs more than Symbicort, roughly $600 to $630 monthly versus $300 to $500
Can worsen narrow-angle glaucoma or urinary retention in susceptible patients
HandiHaler device is approved for COPD only, not asthma
Does not contain an anti-inflammatory steroid, so it doesn't address airway inflammation directly
Common Symptoms and Related Diseases You Can Explore
Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.