Incruse Ellipta vs. Spiriva: Differences, similarities, and which is better for you

In this article:

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost comparison
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost comparison
• Side effects
• Interactions
• Warnings
• FAQs

If you or a loved one has chronic obstructive pulmonary disease (COPD), you may have heard about Incruse Ellipta and Spiriva. Both are long-acting anticholinergic inhalers (also known as long-acting muscarinic antagonists, or LAMAs) used for the maintenance treatment of COPD, helping to manage symptoms such as shortness of breath, wheezing, and coughing.

But which inhaler works better—and which one is more affordable? A 12-week clinical study found that Incruse Ellipta may be slightly more effective than Spiriva, but both improve quality of life and are considered safe. Cost and insurance coverage often play a significant role in determining which option is right for you.

Conditions treated by Incruse Ellipta and Spiriva

Incruse Ellipta and Spiriva are both FDA-approved for the maintenance treatment of chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. 

Spiriva Respimat has one additional indication: maintenance treatment of asthma in patients aged 6 years and older. 

Neither drug is a rescue inhaler or to be used for an acute attack. 

Is Incruse Ellipta or Spiriva more effective?

There is minimal direct data comparing the two drugs. A 12-week clinical trial compared the efficacy and safety of Incruse Ellipta and Spiriva in just over 1,000 people with COPD. The primary endpoint was the trough forced expiratory volume in one second (also called FEV1) at day 85. Patients were evaluated using St George’s Respiratory Questionnaire and other assessments. Both drugs showed meaningful improvements in quality of life and were well-tolerated in terms of safety. The study concluded that Incruse Ellipta was more effective than Spiriva.

Only your healthcare provider can determine the most effective medication for you. They can consider the severity of your symptoms and your medical history, along with other medicines you take that could interact with Incruse Ellipta or Spiriva. 

Coverage and cost comparison of Incruse Ellipta vs. Spiriva

Insurance plans and Medicare Part D cover both Incruse Ellipta and Spiriva, but the coverage amount varies by plan. To determine if your specific plan covers either medication, please contact your plan directly for more information about coverage and costs.

Prescription drug prices often change. These are the most accurate medication prices at the time of publishing in ZIP code November 13, 2025. The listed price without insurance references the price of brand-name drugs (unless otherwise specified). The listed SingleCare price references the price of generic drugs if available.

Common side effects of Incruse Ellipta vs. Spiriva

Incruse Ellipta

• Upper respiratory tract infection
• Cough
• Runny or stuffy nose
• Mouth or throat pain
• Taste changes
• Muscle or joint pain
• Stomach pain
• Tooth pain
• Bruising or dark areas of skin
• Fast or irregular heartbeat
  

Spiriva

Spiriva side effects may vary depending on the formulation (i.e., Handihaler vs. Respimat).

• Upper respiratory infection
• Runny nose
• Sore throat
• Sinusitis
• Bronchitis 
• Cough 
• Chest pain
• Headache 
• Dry mouth
• Constipation
• Indigestion 
• Urinary tract infection

This is not a complete list. Always discuss side effects with your healthcare provider.

Source: DailyMed (Incruse Ellipta), DailyMed (Spiriva)

Drug interactions of Incruse Ellipta vs. Spiriva

Since both inhalers are anticholinergic medications, they should not be combined with other anticholinergics, as this increases the risk of side effects like urinary retention or worsening glaucoma. Examples of anticholinergics include:

• Certain Parkinson’s disease medicines, like benztropine
• Certain drugs for an overactive bladder, like oxybutynin or tolterodine
• Older antihistamines like Benadryl (diphenhydramine)

Before using Incruse Ellipta or Spiriva, check with your healthcare provider to ensure there are no drug interactions. Be sure your provider knows about all the medicines you take, including Rx and OTC drugs, vitamins, and supplements. 

Warnings of Incruse Ellipta and Spiriva

• Do not use Incruse Ellipta or Spiriva Handihaler if you have a severe milk protein allergy. Spiriva Respimat does not contain this warning.
• Not for acute episodes of COPD (use a rescue inhaler instead).
• May cause paradoxical bronchospasm (sudden worsening of breathing). Discontinue and seek emergency care if this occurs.
• May trigger allergic reactions such as rash, swelling, or difficulty breathing. Get emergency medical help if this occurs.
• Tell your healthcare provider about any medical conditions you have, including if you have glaucoma, bladder or prostate problems, heart conditions, or are pregnant or breastfeeding.

Frequently asked questions about Incruse Ellipta vs. Spiriva

Are Incruse Ellipta and Spiriva the same?

No. Both are LAMAs and work similarly, but they contain different active ingredients, come in various forms, and may cause slightly different side effects.

Is Incruse Ellipta or Spiriva better?

Limited data is available comparing Incruse Ellipta to Spiriva. One study showed Incruse Ellipta to be more effective, but both medications were found to be equally safe. Your healthcare provider can determine which drug is better for you. 

Can I use Incruse Ellipta or Spiriva while pregnant?

There is not enough information on the effects of Incruse Ellipta or Spiriva in pregnancy. Consult your obstetrician or gynecologist for medical advice. If you are already taking Incruse Ellipta or Spiriva and find out that you are pregnant, consult your Ob/Gyn. 

Can I use Incruse Ellipta or Spiriva with alcohol?

Although Incruse Ellipta or Spiriva does not interact with alcohol, drinking alcohol over a long time can increase COPD symptoms and weaken your immune system, worsening your COPD symptoms. Consult your healthcare provider for more information about alcohol and COPD. 

Is Incruse Ellipta a steroid?

No. Incruse Ellipta is not a steroid. It is classified as an anticholinergic medication. It relaxes the muscles in the airways, making breathing easier. 

What inhaler is equivalent to Spiriva?

Tudorza Pressair (aclidinium) is another inhaler in the same category as Spiriva and Incruse Ellipta. Multiple inhalers contain more than one active ingredient, including a LAMA. If you are looking for an alternative to Spiriva, discuss options with your healthcare provider.

What’s the best inhaler for COPD?

There is no single “best” inhaler. The choice depends on your medical condition, symptoms, lung function, other health conditions, and insurance coverage. Always consult your doctor for medical advice.