Overview of Combination Asthma Inhalers

Girl using combo inhaler


Advair, Symbicort, Dulera, and Breo are controller medications that combine two drugs into one inhaler (in medical terms: inhaled steroids with a long-acting beta agonist). A number of studies suggest possible benefits of combining these medications into a single inhaler as opposed to prescribing them separately. Additionally, a few studies have suggested the possibility of using a combination product as your only inhaler for both control and acute symptoms, but you should discuss this with your asthma doctor before attempting this.


  • More convenient
  • Increases compliance with drug
  • Less expensive
  • Lower doses of inhaled steroid that can minimize side effects


  • Less flexibility in dosing
  • If you use medication to relieve acute symptoms, you can receive a much higher dose of the steroid than is currently recommended.

How They Work

Combination products like Advair and Symbicort contain 2 active medications that work to treat your asthma differently:

  • Inhaled steroid: Acts on the airways of the lung to decrease inflammation.
  • LABA: Provides bronchodilation by relaxing smooth muscle in the lungs and making the airways wider, thereby decreasing symptoms.


  • Advair: Contains the steroid Fluticasone (Flovent) and the LABA Salmeterol (Serevent)
  • Symbicort: Containing the steroid, Budesonide (Pulmicort) and the LABA Formoterol (Foradil)
  • Dulera: Containing the steroid Mometasone and the LABA Formoterol
  • Breo: Containing the steroid Fluticasone and he LABA Vilanterol

Potential Side Effects

As with most other drugs, only a small percentage of patients experience side effects. Potential side effects are generally similar to those of both the inhaled steroid and the LABAs. All combination steroid and LABAs carry the "Black Box" warning of the other LABAs and the potential side effects of inhaled steroids are similar.

The warning is based on data from one of the original studies evaluating LABAs that sound 13 deaths out of 13,176 patients treated with a LABA for 28 weeks versus deaths in patients receiving placebo (did not receive a LABA) 3 of 13,179. While this number is really small and there were a number of issues with the studies leading to the warning, the FDA felt it prudent for patients to be informed.

In moderate to severe asthma adding a LABA appears that it is more effective than doubling the dose of an inhaled steroid and is the preferred treatment for that reason. As previously mentioned, the combination has allowed some patients to achieve control at lower doses and decrease the risk of side effects due to the lower dose. Current recommendations at initiation of therapy allow for medium-dose inhaled steroid or low-dose steroid plus a LABA.

Can Combination Inhalers Be Used as an Asthmatics Only Inhaler?

Anytime you only need one medication, there is probably a better chance of taking the medication correctly. However, there are a number of reasons why asthmatics normally use more than one inhaler

However, a study published in Lancet indicates that patients with moderate to severe asthma may do better with a single inhaler compared to separate inhalers for maintenance and rescue. Several important metrics were improved in this group such as the risk of a severe asthma attack, hospitalization, or need for urgent care. A second study also seems to support this treatment. Given that a large percentage of asthma patients do not regularly use their asthma controller medications correctly, this may be an option in the future. However, this treatment is not currently supported by U.S. Asthma Guidelines so you need to make sure you discuss it with your asthma provider.


Combination products can be a useful tool for patients that are not able to achieve control of their asthma on an inhaled steroid alone. You and your physician need to discuss the possible risks and benefits of combination therapy and make sure you notify your physician of any worsening of your asthma symptoms.

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