Asthma and chronic obstructive pulmonary disease (COPD) affect millions globally, making effective management essential for a good quality of life. Advair (Advair Diskus and Advair HFA), a commonly prescribed medication for both asthma and COPD, has been a go-to treatment for many. However, despite its widespread use, Advair has several notable disadvantages that make it less than ideal for all patients.

According to clinical data, side effects can affect between 1% to 10% of users, with some experiencing more severe reactions such as muscle pain, anxiety, and rare but serious allergic reactions. Moreover, the high cost of Advair leads to non-adherence, further complicating disease management. With asthma and COPD cases on the rise, the need for effective, affordable, and well-tolerated treatment options is more critical than ever.

This article guides you through the top alternatives to Advair for managing these conditions. We explore medications offering similar benefits, from other inhaled corticosteroids to innovative combination therapies, helping you find a solution that fits your needs for better breathing and improved quality of life.

Key Findings:

  • Wixela Inhub is a generic version of Advair Diskus, containing the same active ingredients at a significantly lower cost, around $50 per month. It demonstrates equivalent efficacy to Advair Diskus and has similar side effects, including throat irritation and headaches.
  • Natural alternatives such as Butterbur and Boswellia have shown some efficacy in managing asthma.
  • Breathing exercises can improve lung function, reduce symptoms, enhance relaxation, and help clear airways. Techniques such as diaphragmatic and pursed-lip breathing can significantly benefit individuals with respiratory conditions.
  • Switching from Advair to an alternative should be done under the guidance of a healthcare provider. Understanding new medication options, getting a prescription, adhering to a transition plan, and scheduling follow-up appointments are essential steps to ensure a smooth and effective transition.

Top 5 Best Alternatives to Advair

Symbicort Turbohaler1. Symbicort (budesonide/formoterol)

Symbicort is an effective treatment for asthma and COPD, offering benefits similar to Advair but differing in formulation and delivery mechanisms. It combines budesonide, an inhaled corticosteroid, with formoterol, a long-acting beta-agonist (LABA). Formoterol, like salmeterol, achieves bronchodilation by relaxing airway smooth muscle, but it has a quicker onset of action compared to salmeterol.

A study compared the efficacy of fluticasone/salmeterol (Advair) and budesonide/formoterol (Symbicort) and found that Symbicort reduced the risk of hospitalizations and emergency room visits by 28%. When used as maintenance and reliever therapy (320/9 mcg per day), it further reduced the risk by 37%. Additionally, this combination prolonged the time to the first severe exacerbation compared to using fluticasone/salmeterol.

Symbicort differs from Advair in its available dosages and delivery method. It is available in doses of 80/4.5 mcg and 160/4.5 mcg per inhalation and is administered via a metered-dose inhaler (MDI), making it a suitable alternative to Advair HFA. One advantage of Symbicort is that it is approved for both asthma and COPD, while Advair HFA is only approved for the treatment of asthma. Symbicort is typically administered more frequently than Advair, with two inhalations twice daily.

Symbicort is priced similarly to Advair, costing around $146 without insurance. Common side effects include headache, throat irritation, hoarseness, and oral thrush, which are similar to those experienced with Advair.

BREO ELLIPTA (Fluticasone furoate and vilanterol)2. Breo Ellipta (fluticasone furoate/vilanterol)

Breo Ellipta contains the same inhaled corticosteroid as Advair but differs in its chemical structure, potency, duration of action, and dosing frequency. While Advair contains fluticasone propionate, Breo Ellipta contains fluticasone furoate. For bronchodilation, Breo Ellipta includes vilanterol, a new ultra-long-acting beta-agonist that provides effective bronchodilation for up to 24 hours.

A 2019 study revealed that fluticasone furoate/vilanterol significantly improved asthma control and quality of life compared to continuing fluticasone propionate/salmeterol in primary care patients, with no notable difference in serious adverse events.

Breo Ellipta, like Advair, is available in three dosages (50/25 mcg, 100/25 mcg, 200/25 mcg) and is administered via oral inhalation powder, making it a suitable alternative to Advair Diskus. An advantage of Breo Ellipta is its once-daily administration.

The price of Breo Ellipta is similar to Advair Diskus, ranging from $146 to $200 for a month’s supply. Side effects are mostly similar to those of Advair Diskus but may also include back pain, oropharyngeal pain, arthralgia, hypertension, influenza, and pyrexia.

Wixela inhaler3. Wixela Inhub (fluticasone propionate/salmeterol)

Wixela Inhub, manufactured by Mylan, is a generic alternative to Advair Diskus. It is designed to deliver the same combination of fluticasone propionate and salmeterol via an inhalation powder. As a generic version, Wixela Inhub provides a cheaper alternative to Advair Diskus for patients without compromising efficacy. A month’s supply is available for as low as $50, making Wixela Inhub an attractive option for many patients and healthcare providers.

Efficacy studies have demonstrated that Wixela Inhub is just as effective as Advair Diskus in managing asthma and COPD. Common side effects include throat irritation, oral candidiasis, and headaches. The dosage and administration are identical to Advair Diskus as well, with one inhalation twice daily.

Trelegy Ellipta4. Trelegy Ellipta (fluticasone/umeclidinium/vilanterol)

Trelegy Ellipta is a triple-combination inhaler containing fluticasone furoate, vilanterol, and umeclidinium. While fluticasone and vilanterol function similarly to the components in Advair (fluticasone and salmeterol), Trelegy’s unique addition is umeclidinium, a long-acting anticholinergic bronchodilator. This component works by relaxing the muscles around the airways, reducing airway constriction, and improving airflow, particularly benefiting individuals with COPD.

One of Trelegy’s notable advantages is its once-daily administration via a dry powder inhaler, providing a convenient alternative to Advair Diskus. This ease of use can be especially beneficial for patients who prefer a simpler medication regimen.

Trelegy Ellipta is highly effective, with clinical studies demonstrating significant improvements in lung function and a reduction in COPD exacerbations. However, note that Trelegy is not suitable for children and adolescents under the age of 18.

The cost of Trelegy Ellipta ranges from $190 to $240 for a 30-dose supply, approximately one month’s worth of medication. While this price may be higher than Advair Diskus, the improved convenience and efficacy can justify the cost for many patients. Common side effects include sore throat and sinusitis.

Related Article

For a detailed comparison of Advair and Trelegy, check out our blog post: Trelegy vs Advair: Which Inhaler is Right for You? This article will discuss the differences, benefits, and potential side effects of Trelegy and Advair, helping you make an informed decision about your respiratory health. Don’t miss this insightful read!

5. Spiriva (tiotropium bromide)

Spiriva contains tiotropium bromide, a long-acting anticholinergic agent. Tiotropium bromide works by blocking muscarinic receptors in the airways, leading to the relaxation of bronchial muscles. This helps to open up the airways and makes breathing easier.

Spiriva is available in two forms–Respimat and HandiHaler. The Respimat inhaler delivers medication as a fine mist, similar to Advair HFA, but without propellants. This can be advantageous for patients who have difficulty coordinating inhalation. The HandiHaler is similar to the Advair Diskus, as both are powder inhalers. However, Spiriva HandiHaler uses capsules containing dry powder, which must be inserted and pierced into the device before inhalation, whereas Advair Diskus contains a pre-metered dose of dry powder within the device.

Spiriva is a cheaper alternative to Advair, priced at around $109 per month. Both forms of Spiriva require two inhalations once daily. Common side effects are similar to those of Advair, including upper respiratory tract infections, dry mouth, and sinusitis.

Natural Alternatives To Advair

While these options are not substitutes for Advair, they can aid in managing asthma and other respiratory illnesses. Natural remedies and lifestyle changes offer holistic approaches to improving lung health and overall well-being. The most studied natural alternatives are:

Herbal Remedies

1. Butterbur (Petasites hybridus)

Butterbur’s active compounds, particularly petasins, have been shown to inhibit leukotriene and histamine activities, which are involved in inflammatory responses in asthma and bronchitis. A study found that butterbur extract could reduce airway hyper-responsiveness and inflammation in mice, suggesting potential benefits for asthma management in humans. However, clinical studies on humans have shown mixed results.

One double-blind study found significant improvement in airflow among asthma patients using butterbur extract compared to a placebo, but there were also indications of increased asthma attack frequency in some cases.

One of the main concerns with butterbur is the presence of pyrrolizidine alkaloids (PAs), which can cause liver toxicity. To avoid these risks, it is crucial to use PA-free butterbur extracts.

2. Boswellia (Boswellia serrata)

Studies suggest that Boswellia serrata, also known as Indian frankincense, may be effective in treating asthma and other respiratory illnesses. Boswellia serrata contains active compounds called boswellic acids, which have anti-inflammatory properties.

A clinical trial published in the European Journal of Medical Research (1998) investigated the effects of Boswellia serrata in patients with bronchial asthma. The study involved 40 patients who were given 300 mg of Boswellia serrata extract three times daily for 6 weeks. The results showed significant improvement in symptoms, including decreased frequency of asthma attacks, improved lung function, and reduced blood eosinophil counts compared to the placebo group.

Dietary Supplements

3. Omega-3 Fatty Acids

Omega-3 fatty acids, commonly found in fish oil, have been studied for their potential benefits in managing asthma and other respiratory illnesses. A study from Johns Hopkins Medicine found that higher dietary intake of omega-3 fatty acids is associated with fewer asthma symptoms in children exposed to indoor air pollution.

In addition, a 2020 study investigated the levels of omega-3 polyunsaturated fatty acids (n-3 PUFA) in the blood (specifically in erythrocyte membranes) and their impact on asthma control. The findings suggest that higher levels of omega-3 fatty acids in the blood are associated with better asthma control and lower doses of inhaled corticosteroids, implying that omega-3 supplements could potentially play a role in managing asthma.

4. Vitamin D

Vitamin D has shown potential benefits in managing asthma and other respiratory conditions, primarily due to its immune-modulating and anti-inflammatory properties. However, research has shown mixed results, with some studies indicating a potential benefit in reducing exacerbations and others showing no significant effect.

One study demonstrated that vitamin D supplementation led to a 30% reduction in asthma exacerbations among patients with mild to moderate asthma and low vitamin D levels. However, a recent review in the Cochrane Database of Systematic Reviews indicated that vitamin D intake is unlikely to improve asthma symptoms or decrease the risk of asthma attacks.

Lifestyle Changes

1. Breathing Exercises

Practicing breathing exercises can greatly help in managing asthma and various respiratory ailments. Here are several ways in which breathing exercises can help:

  • Improving lung function: Breathing exercises can strengthen the respiratory muscles, increase lung capacity, and enhance the respiratory system’s efficiency. Techniques such as diaphragmatic breathing, where one breathes deeply into the diaphragm rather than shallowly into the chest, can help improve lung function over time.
  • Reducing symptoms: Respiratory conditions often cause symptoms like shortness of breath, wheezing, and coughing. Breathing exercises can help reduce these symptoms by promoting better airflow and reducing airway resistance. Techniques like pursed-lip breathing, where one inhales through the nose and exhales slowly through pursed lips, can help keep the airways open longer and reduce breathlessness.
  • Enhancing relaxation: Breathing exercises can activate the parasympathetic nervous system, which promotes relaxation and reduces stress and anxiety. Since stress can exacerbate respiratory conditions, practicing breathing exercises can help manage stress levels and prevent symptom flare-ups.
  • Improving airway clearance: Certain breathing techniques, such as the Huff Cough, can help clear mucus from the airways, making it easier to breathe. This is particularly useful for conditions like COPD, where mucus buildup is a common problem.
  • Enhancing overall respiratory efficiency: Breathing exercises can help improve the efficiency of the respiratory system by optimizing the oxygen and carbon dioxide exchange. This can result in better oxygenation of the blood and tissues, which is crucial for overall health and well-being.
  • Building awareness and control: Regular practice of breathing exercises helps individuals become more aware of their breathing patterns and learn how to control their breath during episodes of breathlessness or asthma attacks. Techniques like the Buteyko Method focus on nasal breathing and breath-holding exercises to help manage asthma symptoms.

More importantly, breathing exercises can complement other treatments for respiratory conditions, such as medication and physical therapy. Integrating breathing exercises into a comprehensive treatment plan can enhance overall effectiveness and improve outcomes.

2. Regular Physical Activity

Exercise can enhance lung function by increasing lung capacity and strengthening respiratory muscles. This helps individuals breathe more easily and effectively. Other benefits of regular physical activity include:

  • Better asthma control: Engaging in regular physical activity can lead to fewer asthma symptoms and attacks. Exercise helps improve the efficiency of oxygen utilization in the body, reducing the frequency and severity of asthma flare-ups.
  • Enhanced immune function: Regular exercise boosts the immune system, making it more effective at fighting infections that can exacerbate respiratory conditions.
  • Reduced inflammation: Physical activity has anti-inflammatory effects, which can help reduce the chronic inflammation associated with asthma and other respiratory conditions.
  • Weight management: Maintaining a healthy weight through regular exercise can lessen the strain on the respiratory system. Obesity can worsen asthma symptoms, so weight management is crucial.
  • Improved cardiovascular health: Exercise improves cardiovascular fitness, which enhances the efficiency of the heart and lungs. Better cardiovascular health can reduce the workload on the respiratory system.
  • Stress reduction: Exercise is a great way to manage stress, which can be a trigger for asthma symptoms. Lower stress levels can lead to fewer asthma exacerbations.
  • Increased physical endurance: Regular physical activity can increase stamina and endurance, making it easier for individuals with respiratory conditions to engage in daily activities without experiencing shortness of breath.

Regular exercise can improve the quality of life for individuals with asthma or other respiratory conditions by enhancing physical health, reducing symptoms, and increasing energy levels.

Alternative Therapies

1. Acupuncture

A 2022 study found that acupuncture can significantly improve dyspnea (shortness of breath) and enhance the health-related quality of life in COPD patients. The researchers concluded that acupuncture might be a beneficial complementary treatment for managing COPD symptoms, supporting its potential integration into broader COPD treatment plans.

2. Salt Therapy (Halotherapy)

Halotherapy is a holistic treatment that involves inhaling microparticles of salt in a controlled environment. This therapy is typically administered in specially designed rooms known as salt caves or salt rooms, which mimic the microclimate of natural salt mines. There are two types of salt therapy:

  • Dry Halotherapy: Involves sitting in a room lined with salt, where a halogenerator crushes pharmaceutical-grade salt into tiny particles and disperses them into the air.
  • Wet Halotherapy: Includes methods such as saltwater baths, salt scrubs, and saltwater inhalation through nebulizers.

According to Dr. Norman Edelman, senior scientific advisor to the American Lung Association, salt therapy could substantially affect people with obstructive lung diseases like COPD. When fine salt particles are inhaled during a salt therapy session, they land on the linings of the airways. This is crucial for individuals with COPD who often struggle with thick sputum (a combination of saliva and mucus) that can be difficult to expel.

Moreover, the salt particles attract water into the airways, a process known as osmosis. The added moisture helps to thin the mucus, making it less sticky and easier to cough up. This can significantly reduce the discomfort and difficulty associated with clearing the airways for COPD patients.

While the potential benefits are promising, no established medical guidelines based on evidence-based research for salt therapy in COPD treatment exist. This means that the therapy should be cautiously approached, and patients should discuss it with their healthcare provider.

Switching From Advair To An Alternative

Switching from Advair to an alternative medication should be done under the guidance of a healthcare provider. Here are the general steps you can follow to ensure a smooth transition:

1. Consult Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your intention to switch. Your doctor can help identify the most suitable alternative based on your medical history, current condition, and specific needs.

2. Understand Your Options

Familiarize yourself with potential alternatives to Advair. Some common options include Symbicort, Breo Ellipta, Wixela Inhub, Trelegy Ellipta, and Spiriva. Understand the differences in ingredients, dosage, administration, and efficacy, and consider the potential side effects of the alternative medications and how they compare to those of Advair.

3. Get a Prescription

Your doctor will prescribe the new medication and provide instructions on dosage and administration. Check with your insurance provider to see if the new medication is covered and understand the cost implications.

4. Transition Plan

Adhere to the transition plan provided by your doctor. This may involve gradually tapering off Advair while starting the new medication. Keep track of your symptoms during the transition period. Report any adverse effects or concerns to your healthcare provider immediately.

5. Education and Training

Ensure you understand how to use the new inhaler or medication device correctly. Ask for a demonstration from your healthcare provider or pharmacist if needed. Make any necessary lifestyle adjustments to support your respiratory health, such as avoiding triggers, maintaining a healthy diet, and following an exercise plan.

Follow-Up Appointments

Schedule follow-up appointments to monitor your progress and make any necessary adjustments to your treatment plan. Assess the effectiveness of the new medication and discuss any concerns or side effects with your doctor.

Switching to an alternative to Advair involves careful planning and coordination with your healthcare provider. By understanding your options, following your doctor’s instructions, and monitoring your symptoms, you can smoothly and effectively transition to a new medication.

Takeaway

When considering alternatives to Advair for managing asthma and COPD, several medications stand out for their efficacy, formulation, and delivery mechanisms. Among these are Symbicort, Breo Ellipta, Wixela Inhub, Trelegy Ellipta, and Spiriva.

Each of these alternatives offers unique formulation, delivery, and cost advantages, allowing patients and healthcare providers to select the most suitable option based on individual needs and preferences. Consulting with a healthcare professional is essential to determine the best treatment plan.

Frequently Asked Questions

What are the common ingredients found in Advair alternatives?

Common ingredients include corticosteroids like budesonide, fluticasone, mometasone, and long-acting beta-agonists like formoterol, salmeterol, vilanterol.

How do I know if an Advair alternative is working for me?

You should notice improved breathing, fewer asthma or COPD symptoms, and reduced need for rescue inhalers. Regular follow-ups with your healthcare provider, including spirometry tests, can help monitor your progress.

Are there specific Advair alternatives recommended for exercise-induced asthma?

Symbicort is commonly prescribed for exercise-induced asthma. Short-acting beta-agonists (SABAs) like albuterol are often used before exercise as a preventive measure.

What are the latest advancements in asthma and COPD treatments beyond Advair alternatives?

New treatments include biologics like omalizumab (Xolair) and mepolizumab (Nucala) for severe asthma, as well as triple therapy inhalers for COPD, combining corticosteroids, long-acting beta-agonists, and long-acting muscarinic antagonists.

Can Advair alternatives be used in children and older adults?

Yes, many Advair alternatives are approved for use in both children and older adults, but the age ranges may vary. For instance, Symbicort is approved for children 6 years and older for asthma, while Trelegy Ellipta is for those 18 and older.

Do Advair alternatives require a prescription?

Yes, all the listed alternatives, such as Symbicort, Breo Ellipta, and Trelegy Ellipta require a prescription from a healthcare provider.

What are the advantages of using an Advair alternative?

Advantages can include similar efficacy, potentially lower cost, different dosing options, and alternative delivery mechanisms that might be easier for some patients to use.

What should I consider when switching from Advair to an alternative medication?

Consider efficacy, side effects, cost, ease of use, and how well the new medication controls your symptoms. Always consult with a healthcare provider before making any changes.

Can Advair alternatives be used in combination with other asthma or COPD medications?

Yes, they can be used in combination with other medications such as short-acting beta-agonists (rescue inhalers) or other maintenance medications, depending on the individual’s treatment plan.

What environmental factors should I consider when using Advair alternatives?

Avoiding exposure to allergens, pollutants, smoke, and extreme weather conditions can help manage asthma and COPD symptoms. Using air purifiers and maintaining good indoor air quality is also beneficial.

Sources

American Lung Association. (n.d.). Promising or placebo? Halo Salt Therapy: resurgence of a salt cave spa treatment. Retrieved from https://www.lung.org/blog/promising-placebo-salt-halotherapy

You, T. Y., Zhang, H. Y., Li, J. Q., & Ma, T. M. (2022). Effectiveness and safety of acupuncture for chronic obstructive pulmonary disease: A protocol for systematic review and meta-analysis. Medicine, 101(2), e28555. https://doi.org/10.1097/MD.0000000000028555

Williamson, A., Martineau, A. R., Sheikh, A., Jolliffe, D., & Griffiths, C. J. (2023). Vitamin D for the management of asthma. Cochrane Library, 2023(2). https://doi.org/10.1002/14651858.cd011511.pub3

Tibrewal, C., Modi, N. S., Bajoria, P. S., Dave, P. A., Rohit, R. K., Patel, P., Gandhi, S. K., Gutlapalli, S. D., Gottlieb, P., & Nfonoyim, J. (2023). Therapeutic Potential of Vitamin D in Management of Asthma: A Literature Review. Cureus, 15(7), e41956. https://doi.org/10.7759/cureus.41956

Stoodley, I., Garg, M., Scott, H., Macdonald-Wicks, L., Berthon, B., & Wood, L. (2019). Higher Omega-3 Index Is Associated with Better Asthma Control and Lower Medication Dose: A Cross-Sectional Study. Nutrients, 12(1), 74. https://doi.org/10.3390/nu12010074

Johns Hopkins Medicine Media Team. (2019, March 29). Omega-3 fatty acids tied to fewer childhood asthma symptoms. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/news/newsroom/news-releases/2019/03/omega-3-fatty-acids-tied-to-fewer-childhood-asthma-symptoms

Gupta, I., Gupta, V., Parihar, A., Gupta, S., Lüdtke, R., Safayhi, H., & Ammon, H. P. (1998). Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study. European journal of medical research, 3(11), 511–514. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9810030/

Butterbur – Health Information Library | PeaceHealth. (n.d.). Retrieved from https://www.peacehealth.org/medical-topics/id/hn-4409006

Jacques, L., Bakerly, N. D., New, J. P., Svedsater, H., Lay-Flurrie, J., & Leather, D. A. (2019). Effectiveness of fluticasone furoate/vilanterol versus fluticasone propionate/salmeterol on asthma control in the Salford Lung Study. The Journal of asthma : official journal of the Association for the Care of Asthma, 56(7), 748–757. https://doi.org/10.1080/02770903.2018.1490751

Fragkaki, A., Georgakopoulos, C., Sterk, S., & Nielen, M. (2013). Sports doping: Emerging designer and therapeutic ?2-agonists. Clinica Chimica Acta, 425, 242–258. https://doi.org/10.1016/j.cca.2013.07.031

Lindmark, B. (2008). Review: Differences in the pharmacodynamics of budesonide/formoterol and salmeterol/fluticasone reflect differences in their therapeutic usefulness in asthma. Therapeutic Advances in Respiratory Disease, 2(5), 279–299. https://doi.org/10.1177/1753465808096135

Kuna, P. (2010). Treatment Comparison of Budesonide/Formoterol with Salmeterol/Fluticasone Propionate in Adults Aged ?16 Years with Asthma. Clinical Drug Investigation, 30(9), 565–579. https://doi.org/10.2165/11533450-000000000-00000