Asthma Inhalers Explained: Symbicort vs Spiriva vs Trelegy – What's the Difference?
Medical Disclaimer: This article is for general informational purposes only and does not constitute medical advice, diagnosis or treatment. Prescription inhalers have specific indications, contraindications, warnings, strengths and formulations that may vary by product and country. Always consult your doctor, pharmacist or another qualified healthcare professional before starting, stopping or changing any medication.
Asthma treatment is not the same for everyone. Depending on the severity and pattern of symptoms, a healthcare professional may prescribe an inhaled corticosteroid, a bronchodilator, or a combination of medicines.
Symbicort, Spiriva and Trelegy Ellipta are different types of inhaled medicines, and they should not be treated as interchangeable products. They contain different active ingredients, use different inhaler devices and have different approved indications depending on the country and formulation.
This guide explains the main differences between these medicines and what to check when ordering prescription inhalers online.
Understanding Asthma
Asthma is a chronic respiratory condition involving inflammation and narrowing of the airways.
Symptoms can include:
Wheezing
Coughing
Shortness of breath
Chest tightness
Breathing difficulties that vary over time
Asthma can be influenced by factors such as allergens, respiratory infections, smoke, exercise and other environmental triggers. The pattern differs from person to person, which is why treatment needs to be individualised.
A healthcare professional may use symptoms, medical history and lung-function testing to help confirm the diagnosis and assess asthma control.
Why Asthma Inhalers Are Different
Inhalers do not all perform the same role.
Some contain an inhaled corticosteroid (ICS) to address airway inflammation. Others contain bronchodilators that help relax airway muscles. Some products combine two or three medicines in one device.
This distinction matters because a maintenance inhaler should not automatically be used as a rescue inhaler.
The Global Initiative for Asthma (GINA) recommends inhaled corticosteroid-containing treatment for asthma, with therapy reviewed according to factors such as symptoms, exacerbation risk, lung function, inhaler technique and treatment response.
Symbicort
Symbicort contains budesonide and formoterol.
Budesonide is an inhaled corticosteroid, while formoterol is a long-acting beta2-agonist (LABA).
Together, these medicines can provide anti-inflammatory treatment and bronchodilation.
Symbicort is used for asthma in certain markets and formulations. However, the exact strength, dosing instructions and whether it is used as maintenance treatment alone or as part of a maintenance-and-reliever regimen depend on the applicable product information and the patient's prescription.
For example, U.S. product information includes Symbicort 80/4.5 mcg and 160/4.5 mcg inhalation aerosol formulations.
Patients should therefore check the exact strength and formulation on their prescription rather than assuming that all Symbicort products are identical.
What Does Symbicort Do?
The two active ingredients have different roles:
Budesonide: an inhaled corticosteroid that helps reduce airway inflammation.
Formoterol: a long-acting bronchodilator that helps relax airway muscles.
The combination may be prescribed as part of an asthma treatment plan appropriate to the patient.
The exact way Symbicort should be used depends on the prescribed regimen. Do not assume that the same inhaler can be used as both a maintenance and reliever medicine unless your healthcare professional has specifically prescribed it that way.
Spiriva
Spiriva contains tiotropium, which belongs to a class of medicines called long-acting muscarinic antagonists (LAMAs).
However, the formulation and device matter considerably with Spiriva.
This is an important distinction when purchasing the medicine online.
Spiriva HandiHaler
Spiriva HandiHaler uses 18 mcg tiotropium capsules that are used with the HandiHaler device.
The U.S. prescribing information identifies Spiriva HandiHaler as a once-daily maintenance treatment for COPD. The capsules are specifically designed for use with the HandiHaler device and should not be swallowed.
Therefore, an 18 mcg Spiriva HandiHaler capsule should not simply be described as a generic asthma inhaler.
Spiriva Respimat
Spiriva Respimat is a different formulation and delivery device.
In U.S. product information, Spiriva Respimat has been indicated for maintenance treatment of asthma as well as COPD, with different strengths used for the different indications.
This illustrates why the device, formulation, strength and indication all need to be checked together.
A product labelled simply as “Spiriva 18 mcg” does not provide enough information to determine whether it is the appropriate product for an asthma prescription.
Trelegy Ellipta
Trelegy Ellipta is a triple-combination inhaler.
It contains:
Fluticasone furoate — an inhaled corticosteroid
Umeclidinium — a long-acting muscarinic antagonist
Vilanterol — a long-acting beta2-agonist
In the U.S., Trelegy Ellipta is approved for maintenance treatment of both COPD and asthma in appropriate patients. It is not intended to provide relief of acute bronchospasm.
U.S. product information lists:
100/62.5/25 mcg
200/62.5/25 mcg
for asthma maintenance treatment.
The available strengths and approved uses can differ by country, so patients should check the product information applicable to their location.
Symbicort vs Spiriva vs Trelegy: What's the Difference?
Feature | Symbicort | Spiriva | Trelegy Ellipta |
Active ingredients | Budesonide + formoterol | Tiotropium | Fluticasone furoate + umeclidinium + vilanterol |
Main medicine classes | ICS + LABA | LAMA | ICS + LAMA + LABA |
Device/formulation | Depends on product and market | HandiHaler or Respimat, depending on product | Ellipta inhaler |
Asthma use | Yes, for approved formulations/indications | Depends on formulation and market | Yes, for approved formulations/indications |
COPD use | Depends on market/product | Yes for appropriate formulations | Yes |
Acute symptom relief | Depends on prescribed regimen | Not a rescue medicine | Not a rescue medicine |
The table is intentionally general because the same brand name can encompass different formulations, strengths and approved uses in different markets.
Which Inhaler Is Right for Asthma?
There is no single inhaler that is best for every person with asthma.
Your healthcare professional may consider:
How often you experience symptoms
Previous asthma attacks or exacerbations
Lung-function results
Current medicines
How well your current treatment controls symptoms
Other medical conditions
Inhaler technique
Your ability to use the particular device correctly
Your preferences and treatment goals
GINA recommends a continuing cycle of assessment, treatment adjustment and review, rather than choosing an inhaler based only on the brand name.
Why the Inhaler Device Matters
Two medicines can contain similar types of active ingredients but use completely different inhaler devices.
This affects how the medicine is prepared and inhaled.
For example:
Spiriva HandiHaler uses capsules with a dedicated device.
Spiriva Respimat uses a cartridge and Respimat inhaler.
Trelegy Ellipta uses the Ellipta inhaler.
Symbicort is available in specific formulations and devices depending on the market.
Patients should not assume that inhalers are interchangeable simply because they are all used for respiratory conditions.
If you receive a different device from the one you were prescribed, speak with your pharmacist before using it.
Why Strength and Formulation Matter
This is particularly important when ordering inhalers online.
Check the:
Brand name
Active ingredients
Strength
Dosage form
Inhaler/device
Quantity
Manufacturer
Batch or lot number
Expiry date
For Spiriva in particular, the difference between HandiHaler 18 mcg capsules and Respimat inhalation spray demonstrates why the strength alone does not tell the whole story.
Packaging may also differ legitimately between countries. If the medicine you receive does not match your prescription, contact the supplying pharmacy before using it.
Maintenance Inhalers Are Not Automatically Rescue Inhalers
One of the most important points for patients is understanding the role of their inhaler.
Some inhalers are used regularly to control the underlying condition, while others are prescribed for symptom relief.
For example, Spiriva Respimat is described in U.S. prescribing information as a maintenance bronchodilator and is not indicated for immediate relief of acute bronchospasm. Trelegy Ellipta is also not indicated for acute symptom relief.
The appropriate reliever depends on the patient's treatment plan.
If you are experiencing a sudden or severe worsening of breathing, follow your prescribed asthma action plan and seek urgent medical attention when required.
Asthma and Allergies
Allergens can trigger asthma symptoms in some people.
Potential triggers include:
Pollen
Dust mites
Mould
Pet allergens
Smoke
Air pollution
Identifying and reducing relevant triggers may form part of an overall asthma-management plan.
However, not every person with asthma has allergies, and allergy treatment does not replace appropriate asthma treatment.
Supporting Better Asthma Control
Medication is only one part of asthma management.
Depending on your circumstances, your healthcare professional may recommend:
Avoiding known triggers
Following an asthma action plan
Learning the correct inhaler technique
Attending regular reviews
Staying physically active as appropriate
Avoiding tobacco smoke
Managing relevant allergies or other conditions
Inhaler technique deserves particular attention because using an inhaler incorrectly can reduce the amount of medicine reaching the lungs. GINA specifically includes inhaler technique and adherence among the factors that should be reviewed when assessing asthma control.
Buying Asthma Inhalers Online
Ordering prescription inhalers online can be convenient, particularly for established treatment plans and repeat prescriptions.
However, prescription medicines should be purchased through an appropriately authorised pharmacy and in accordance with applicable local requirements.
Before ordering, check:
Whether a prescription is required
Pharmacy licensing or authorisation information
Product name and active ingredients
Strength and formulation
Inhaler device
Expiry and packaging information
Delivery conditions
Any destination-country requirements
For international orders, medicine regulations and approved indications can differ between countries.
Avoid websites that offer prescription inhalers without appropriate prescription requirements or make unrealistic claims about treating asthma.
What to Check When Your Inhaler Arrives
Before using an inhaler ordered online, compare the product with your prescription.
Check the:
Medicine: Is the brand or active ingredient correct?
Strength: Does it match your prescription?
Device: Is it the correct inhaler?
Formulation: Is it the expected spray, powder, capsule or cartridge?
Packaging: Is it intact and appropriately labelled?
Expiry: Is the medicine within its expiry period?
If anything appears inconsistent, contact the supplying pharmacy or your healthcare professional before using the product.
About Gaia Pharmacy
Gaia Pharmacy provides an online platform for customers looking to access medicines, subject to applicable prescription and regulatory requirements.
For prescription inhalers, customers should check the prescribed medicine, strength, formulation and device carefully before ordering.
Availability and delivery arrangements may depend on the product and destination.
Frequently Asked Questions
Can I buy asthma inhalers online?
Prescription asthma inhalers may be available through appropriately authorised online pharmacies where permitted by applicable regulations. Prescription requirements vary by medicine and location.
Is Symbicort the same as Spiriva?
No. Symbicort contains budesonide and formoterol, while Spiriva contains tiotropium. They belong to different medicine classes and are not interchangeable.
Is Spiriva 18 mcg used for asthma?
This depends on the formulation and market. Spiriva HandiHaler 18 mcg is identified in U.S. prescribing information as a COPD maintenance product, while Spiriva Respimat has asthma indications in U.S. product information.
Always check the exact formulation and prescribing information applicable to the medicine you have been prescribed.
What is Trelegy Ellipta used for?
Trelegy Ellipta is a combination inhaler containing fluticasone furoate, umeclidinium and vilanterol. In the U.S., it is approved for maintenance treatment of asthma in appropriate adults as well as COPD.
Approved uses can differ between countries.
Is Trelegy Ellipta a rescue inhaler?
No. U.S. prescribing information states that Trelegy Ellipta is not indicated for relief of acute bronchospasm.
Use the reliever medicine included in your prescribed asthma treatment plan.
Which is better: Symbicort, Spiriva or Trelegy?
There is no universally best option. The appropriate inhaler depends on the individual's diagnosis, asthma control, previous treatment, other medicines, inhaler technique and applicable prescribing guidance.
Can I switch between asthma inhalers?
Do not switch inhalers or calculate equivalent doses yourself. Different products contain different active ingredients, strengths and devices. Speak with your doctor or pharmacist if you need to change treatment.
What should I do if my inhaler looks different from the one I normally use?
Do not assume that the product is incorrect or correct based on appearance alone. Packaging can differ between manufacturers and countries. Check the active ingredient, strength, formulation and device against your prescription and contact the supplying pharmacy if you are unsure.
Final Thoughts
Symbicort, Spiriva and Trelegy Ellipta are different prescription inhalers, not interchangeable versions of the same medicine.
Symbicort combines an inhaled corticosteroid with a LABA. Spiriva contains the LAMA tiotropium, but its formulation and device are particularly important when determining its indication. Trelegy Ellipta combines an inhaled corticosteroid, LAMA and LABA.
The right choice depends on the patient's diagnosis, treatment history and individual circumstances. Approved indications and available formulations can also vary between countries.
If you order an inhaler online, check the active ingredients, strength, formulation and device against your prescription and use an appropriately authorised pharmacy.
