Drug vs. Drug

Breo vs. Advair: Differences, similarities, and which is better for you

Avatar By | January 9, 2020

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Breo and Advair are both inhaled prescription drugs indicated for COPD (chronic obstructive pulmonary disease) and asthma treatment. Each drug contains an inhaled corticosteroid (ICS) along with a long-acting beta2-adrenergic agonist (LABA).

The ICS component, which is fluticasone in each medication, helps decrease inflammation in the lungs. The LABA component, which is vilanterol in Breo and salmeterol in Advair, helps to open the airways in the lungs by relaxing the muscles. Breo is available in brand name only; it is made by GSK, or GlaxoSmithKline.

Advair is available in brand and generic; the brand is also made by GSK. Mylan makes a branded generic (a generic drug with a proprietary name), called Wixela Inhub. Breo and Advair are powder inhalers, meaning that the contents of a capsule are inhaled. Advair HFA is a metered-dose inhaler. Breo and Advair have many similarities, but also some notable differences.

What are the main differences between Breo vs. Advair?

Main differences between Breo and Advair
Breo Advair
Drug class ICS (inhaled corticosteroid) and LABA (long-acting beta2-adrenergic agonist) ICS (inhaled corticosteroid) and LABA (long-acting beta2-adrenergic agonist)
Brand/generic status Brand Brand and generic
What is the generic name? Fluticasone furoate/vilanterol Fluticasone propionate/ salmeterol
What form(s) does the drug come in? Breo Ellipta inhaler Advair Diskus and generic,
Fluticasone Advair HFA metered-dose inhaler (per actuation)
What is the standard dosage? COPD maintenance: Breo Ellipta 100/25: 1 puff once daily
Asthma: Breo Ellipta 100/25 or 200/25: 1 puff once daily
*Always rinse mouth after using, to reduce the risk of oral thrush
Advair Diskus and generic,
Asthma maintenance: 1 puff (100/50, 250/50, or 500/50) every 12 hours
COPD maintenance: 1 puff (250/50) every 12 hours
Advair HFA:
Asthma maintenance: 2 puffs inhaled every 12 hours
*Always rinse mouth after using, to reduce the risk of oral thrush
How long is the typical treatment? Varies Varies
Who typically uses the medication? Adults 18 and older Adults and children 4 years and older

Conditions treated by Breo vs. Advair

Many patients suffer from COPD or severe asthma, with symptoms such as wheezing and shortness of breath occurring during asthma attacks. Breo is a once-daily treatment used in patients with COPD or asthma. It can be used in patients 18 years and older. Advair is a twice-daily treatment for patients with COPD or asthma. It can be used in patients four years and older. These medications are not to be used in patients with acute bronchospasm or asthma that can be managed by ICS and occasional use of inhaled short-acting beta2-agonists (such as albuterol, also known in brand name forms as ProAir HFA, Proventil HFA, and Ventolin HFA).

Condition Breo Advair
Long-term, once-daily, maintenance treatment of airflow obstruction and reducing exacerbations in patients with COPD Yes No
Once-daily treatment of asthma in patients aged 18 years and older Yes No
Twice-daily maintenance treatment of asthma in patients four years of age and older No Yes
Twice-daily maintenance treatment of airflow obstruction and reducing exacerbations in patients with COPD No Yes

Is Breo or Advair more effective?

In a six-month randomized, placebo-controlled study comparing Breo to Advair in 806 asthma patients, both treatment groups experienced equivalent improvements in FEV1 (forced expiratory volume; a measure of how much air can be exhaled in one second after a deep inhalation), quality of life scores, and asthma control scores. There were no differences in exacerbation rates, and both drugs were well-tolerated.

Three studies compared Breo and Advair in patients 40 and older with moderate to severe COPD. At the end of the 12-week study, the researchers concluded that both drugs resulted in similar clinical improvements and both drugs have similar safety profiles.

Coverage and cost comparison of Breo vs. Advair

Breo and Advair are usually covered by insurance as well as Medicare Part D. Copays vary widely. Although generics are less expensive in general, some insurance companies prefer the brand Advair due to contract agreements. The average price of Breo without insurance is $450 but you can get it for around $279 with a SingleCare coupon. The average price of Advair Diskus is $474 for brand and as low as $105 for the generic.

Breo Advair
Typically covered by insurance? Yes Yes
Typically covered by Medicare Part D? Yes Yes
Standard dosage Example: 200 mcg/25 mcg inhaler: 1 puff daily Example: Advair Diskus 250 mcg/50 mcg: 1 puff twice daily
Typical Medicare Part D copay $19-$400, varies $40-$400, varies
SingleCare cost $279 $105

Common side effects of Breo vs. Advair

With Breo, the most common side effects are nasopharyngitis (a minor throat infection), upper respiratory tract infection, oral thrush (fungus in the mouth), and headache. Advair side effects are similar, with a slightly higher incidence of pharyngitis, as well as gastrointestinal issues like nausea, vomiting, diarrhea, and headache.

To help reduce the risk of oral thrush, patients should always rinse and spit with water after each dose of Breo or Advair.

In terms of safety, there is an increased risk of asthma-related death with the use of a LABA alone. However, the FDA announced in 2017 that an  ICS/LABA combination such as Breo or Advair does not result in an increased risk of death.

Other side effects may occur. Consult your healthcare professional for a complete list of side effects.

   Breo     Advair
Side Effect Applicable? Frequency Applicable? Frequency
Nasopharyngitis Yes 9% Yes 5%
Upper respiratory tract infection Yes 7% Yes 21-27%
Oral thrush Yes 5% Yes 1-4%
Headache Yes 7% Yes 12%
Pharyngitis Yes 2% Yes 10-13%
Nausea, vomiting, diarrhea No Yes 4%

Source: DailyMed (Breo), DailyMed (Advair)

Drug interactions of Breo vs. Advair

Because Breo and Advair both contain fluticasone, as well as a LABA, they have a similar list of drug interactions. Certain drugs called CYP3A4 inhibitors, interact with Breo and Advair by increasing the levels of the medications. Certain antidepressants in the MAO inhibitor category such as selegiline, Eldepryl, rasagiline, or Azilect, and in the tricyclic antidepressant category—amitriptyline, Elavil, nortriptyline or Pamelor, also interact with Breo and Advair. Beta blockers, such as metoprolol or atenolol, loop diuretics such as furosemide, and thiazide diuretics such as hydrochlorothiazide, also interact with Breo or Advair.

Drug Drug Class Breo Advair
Ketoconazole
Ritonavir
Clarithromycin
Conivaptan
Indinavir
Nefazodone
and others
CPY3A4 inhibitors Yes Yes
Selegiline
Rasagiline
MAOI (monoamine oxidase inhibitor) Yes Yes
Amitriptyline
Nortriptyline
Tricyclic antidepressants Yes Yes
Metoprolol
Atenolol
and others
Beta blockers Yes Yes
Furosemide
Hydrochlorothiazide
Loop or thiazide diuretics Yes Yes

Warnings of Breo vs. Advair

Both drugs come with a long list of warnings.

  • Breo or Advair should not be started in a life-threatening episode of COPD or asthma.
  • To avoid overdose, Breo or Advair should be used as directed by your doctor, at the prescribed dose, and should not be taken with another LABA.
  • Rinse and spit with water after each dose of Breo or Advair to avoid oral thrush (yeast).
  • Monitor for increased risk of pneumonia.
  • Patients with a suppressed immune system due to certain medical conditions or medications are at higher risk for infection when taking Breo or Advair.
  • Use caution when transferring a patient from oral steroids (such as prednisone) to Breo or Advair.
  • Patients should be carefully monitored for signs of systemic steroid absorption, such as hypercorticism and adrenal suppression when taking Breo or Advair.
  • Breo or Advair may lead to life-threatening paradoxical bronchospasm (airway hyperresponsiveness). If this happens, the patient should be treated with a short-acting bronchodilator.
  • The LABA can cause increases in pulse rate or blood pressure, as well as cardiac arrhythmias. Use with caution in patients with heart problems.
  • Long-term use of ICS may lead to increased risk of fractures, as well as glaucoma and cataracts.
  • Monitor for increased blood sugar and decreased potassium.
  • Monitor growth in children and adolescents.
  • Monitor for immediate hypersensitivity reactions (itching, angioedema, rash, cough, low blood pressure), including anaphylaxis. Patients with a severe milk protein allergy should not use Breo or Advair.
  • Advair should be used with caution in patients with certain convulsive disorders or thyrotoxicosis.

There are no adequate, well-controlled studies of Breo and Advair in pregnant women. The drug should only be used in pregnancy if the benefit to the mother outweighs the risk to the fetus, and only with the approval of your doctor. If you are already taking Breo or Advair and find out you are pregnant, consult your healthcare provider.

Frequently asked questions about Breo vs. Advair

What is Breo?

Breo contains an ICS and LABA and is used to treat patients with COPD or asthma. It is used once a day and can be used in patients 18 years and older.

What is Advair?

Advair contains an ICS and LABA and is used to treat patients with COPD or asthma. It is used twice a day and can be used in patients 4 years and older.

Are Breo vs. Advair the same?

Both drugs contain the same ICS (fluticasone) as well as a LABA. The LABA in Breo is called vilanterol and the LABA in Advair is called salmeterol. Both drugs are very similar but have some differences. For example, Advair is used twice daily, while Breo is used once daily.

Is Breo vs. Advair better?

That depends. Many patients notice symptom improvement with either medication. Your doctor can help you decide if Breo or Advair is the right drug for you.

Can I use Breo vs. Advair while pregnant?

Because Breo and Advair have not been evaluated in pregnant women, only use the drug with approval of your doctor if he/she decides the benefit outweighs the risk. If you are already using Breo or Advair and find out you are pregnant, consult your doctor for medical advice.

Can I use Breo vs. Advair with alcohol?

The manufacturer’s information for Breo and Advair does not mention alcohol. Consult your healthcare provider for guidance.

How do asthma preventer medications work?

The ICS in Breo and Advair helps to decrease inflammation in your lungs, while the LABA relaxes the muscles and opens the airways. By doing so, your asthma or COPD symptoms should improve.

Is Breo more expensive than Advair?

It depends on your insurance plan. The price of Breo compared to Advair is similar. You can save money by using manufacturer coupons or checking out SingleCare.com for coupons.

Are Breo and Symbicort the same thing?

Breo and Symbicort are similar. Breo contains the ICS fluticasone and the LABA vilanterol. Symbicort also contains an ICS, called budesonide, as well as a LABA, called formoterol.

What does Breo do for your lungs?

The ICS in Breo helps decrease inflammation in the lungs, while the LABA helps relax the muscles and open the airways. This will help improve symptoms of asthma or COPD.

What inhaler is comparable to Advair?

Dulera (mometasone/formoterol), Symbicort (budesonide/formoterol), and Breo (fluticasone/vilanterol) are all similar to Advair. All of these medications contain an ICS and a LABA.