Symbicort (generic name: budesonide and formoterol) and Advair (generic name: fluticasone and salmeterol) are similar in that they both contain an inhaled corticosteroid (a “steroid”) and an inhaled bronchodilator in one device; however, they have different uses and come in different forms. Symbicort and Advair Diskus are both approved for the maintenance treatment of asthma and chronic obstructive pulmonary disease (COPD), while Advair HFA is only approved for the maintenance treatment of asthma.

• Symbicort is an inhaled aerosol that contains budesonide, a corticosteroid that lessens inflammation in your lungs and formoterol, a long acting beta-2 agonist bronchodilator that helps to relax the muscles around your airways to ease breathing. It comes in a metered-dose inhaler (also called a hydrofluoroalkane or HFA inhaler).
• Advair HFA is an inhaled aerosol in a metered-dose inhaler that contains similar, but different active ingredients from Symbicort: fluticasone propionate, a corticosteroid and salmeterol, a bronchodilator.
• Advair Diskus is an inhaled dry-powder form but contains the same ingredients as the aerosol form of Advair HFA. It comes in a disc-shaped inhaler that contains foil packets of the dry powder.

Who can use Symbicort and Advair?

Symbicort is made by AstraZeneca and was first FDA-approved in 2006.

• It is approved for use in patients 6 years and older for the treatment of asthma. It is also used for the maintenance treatment of chronic obstructive pulmonary disease (COPD) including chronic bronchitis and/or emphysema.
• Symbicort is taken as 2 puffs 2 times each day, morning and evening, about 12 hours apart.
• Symbicort comes in two different strengths: budesonide 80 micrograms (mcg) / formoterol 4.5 mcg and budesonide 160 mcg / formoterol 4.5 mcg. Symbicort 160/4.5 is also indicated to reduce exacerbations of COPD. Symbicort 160/4.5 is the only strength approved for the treatment of COPD.
• It's available in a pressurized metered-dose aerosol canister containing 60 or 120 metered inhalations and fitted with a counter.

Advair HFA, from GlaxoSmithKline, was first approved in 2006.

• Advair HFA is used in adults and children 12 years of age and older for the treatment of asthma. It is not approved for use in COPD. Advair Diskus, a different product, is used in COPD.
• Advair HFA is NOT indicated for the relief of acute bronchospasm, such as an asthma attack. A fast-acting inhaler, such as albuterol, should be used for sudden breathing emergencies.
• Advair HFA is taken as 2 puffs 2 times each day, morning and evening, about 12 hours apart. After each inhalation, rinse your mouth with water without swallowing.
• Advair HFA comes in three different strengths: 45 micrograms (mcg) fluticasone / 21 mcg salmeterol, 115 mcg fluticasone / 21 mcg salmeterol, and 230 mcg fluticasone / 21 mcg salmeterol. It’s a pressurized aerosol canister containing 60 or 120 metered inhalations and fitted with a counter.

Advair Diskus, also from GlaxoSmithKline, was first approved in 2000.

• Advair Diskus is used in adults and children 4 years of age and older for the treatment of asthma. It is also used for the maintenance treatment of COPD and to reduce exacerbations.
• Advair Diskus is taken as one puff inhaled twice a day. It is NOT used for relief of sudden breathing symptoms in either COPD or asthma.
• Advair Diskus comes in three different strengths: 100 mcg fluticasone / 50 mcg salmeterol, 250 mcg fluticasone / 50 mcg salmeterol, and 500 mcg fluticasone / 50 mcg salmeterol. The lowest strength (100/50) is used in children 4 to 11 years for asthma. The 250 mcg / 50 mcg strength is used for COPD.
• It comes in a disk inhaler as a dry-powder formulation containing 60 foil blister strips and is fitted with a dose counter.

Which is safer: Symbicort or Advair?

Symbicort and Advair products are well-tolerated by most patients. The medicine is delivered directly to the lungs which helps to limit side effects. Some commonly reported side effects, occurring in at least 3% of patients (3 out of every 100) include:

Symbicort:

• Asthma: common cold, headache, upper respiratory tract infection, throat pain, oral thrush, sinusitis (inflammation of the sinus membranes), the flu, back pain, nasal congestion, stomach pain, vomiting.
• COPD: common cold, oral thrush, bronchitis, sinusitis, upper respiratory tract infection.

Advair HFA:

• Asthma: upper respiratory tract infection or inflammation, throat irritation, hoarseness, headache, dizziness, nausea and vomiting.

Advair Diskus:

• Asthma: upper respiratory tract infection or inflammation, sore throat, hoarseness, oral thrush, bronchitis, cough, headache, nausea and vomiting.
• COPD: pneumonia, oral thrush, sore throat, hoarseness, viral respiratory infections, headaches, muscle and bone pain.

To help prevent the development of thrush (white patches) in the mouth or throat, rinse your mouth with water, and spit it out, after each inhalation.

Other side effects, drug interactions, and warnings exist with these medications, so it’s important to tell your doctor and pharmacist about your full medical history and other medicines you use, including over-the-counter drugs, herbal products and vitamins or other dietary supplements. They can most effectively review these drugs for safety based on your specific needs.

Which is more effective: Symbicort or Advair?

These products are very effective when you use them daily as prescribed by your doctor. In asthma and COPD, Symbicort and Advair should work similarly. However, the active ingredients and devices are different and some people may find that one works better for them than the other.

Inhaling an aerosol, such as with Symbicort or Advair HFA is a different technique than inhaling the dry-powder formulation with the Advair Diskus. If you have trouble inhaling from any device, be sure to let your doctor or pharmacist know. They might be able to get you a spacer for your aerosol inhaler or help you with your technique.

Which is more expensive: Symbicort and Advair?

Symbicort, Advair HFA and Advair Diskus are available in the original brand name products, which all can be expensive. Symbicort and Advair DIskus also come as generic or brand alternative options, which can help to save you quite a bit of money. A generic for Advair HFA is not yet available.

Prices can vary based on strengths, pharmacy, and even which part of the country you are in. If you have insurance, you may have a lower copay with a generic, so be sure to check with your insurance company to see if one product is preferred over another. These prices are always subject to change over time, too.

Brands name cash costs per inhaler (using an online discount):

• Symbicort: $250-$300
• Advair HFA: $325-$550
• Advair Diskus: $325-$550

Generic or branded alternative cash costs per inhaler (using an online discount):

• budesonide / formoterol (generic for Symbicort): $150-$300
• fluticasone / salmeterol (AirDuo, same medicine as Advair HFA, but slightly different strengths): $50-$90
• fluticasone / salmeterol (Wixela Inhub, generic for Advair Diskus)): $80-$180

The manufacturers of both Symbicort (AstraZeneca) and Advair (GlaxoSmithKline) may have patient assistance programs that can help with cost and copays, too. Contact them directly.

Bottom Line

• Symbicort, Advair HFA and Advair Diskus are all inhaled medications that treat lung diseases like asthma or COPD. They all contain a combination of an inhaled corticosteroid, to help lower lung inflammation, and an inhaler bronchodilator, to help relax the muscles around your airways and ease your breathing.
• Symbicort and Advair HFA come as a metered-dose inhaler (HFA inhaler) containing an aerosol, and Advair Diskus comes as a disk-shaped inhaler that delivers a dry-powder formulation. You may find one product easier to use than the other.
• These medicines are usually very well-tolerated with minimal side effects, as their primary action is delivered directly to the lungs. Common side effects include throat irritation, oral thrush, and respiratory tract infections.
• Brand names products can be very expensive when paying cash, but lower-cost options are available these products.

This is not all the information you need to know about Symbicort, Advair HFA or Advair Diskus for safe and effective use. Review the full information for each product here, and discuss this information with your doctor or other health care provider.