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

Most common
Sinusitis (≥3%)
Headache (≥3%)
Nasopharyngitis (≥3%)
Upper respiratory tract infection (≥3%)

Spiriva

Most common
Sinusitis (up to 6.5%)
Headache (up to 5.7%)
Pharyngitis (up to 12.5%)
Constipation (up to 5.1%)

Symbicort vs. Spiriva Dosage

Symbicort

Dosage
Dosage Table
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

Dosage
Dosage Table
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

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