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Trelegy Ellipta vs. Symbicort for Asthma

Written by Andrew Le, MD

UpdatedMay 29, 2024

Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, affecting 8.3% of Americans - 26.5 million people. Of these 26.5 million asthma sufferers, 20.4 million are adults, and 6.1 million are children.

Managing asthma often involves using inhalers containing various medications that address airway constriction, inflammation, and hyperresponsiveness.

Two combination inhalers frequently prescribed for asthma maintenance are Trelegy Ellipta and Symbicort. Both aim to control symptoms and prevent exacerbations through anti-inflammatory and bronchodilating mechanisms.

This article will provide an in-depth overview comparing Trelegy Ellipta and Symbicort to help inform discussions between patients and healthcare providers regarding asthma treatment options.

🔑 Key Takeaways

  • Trelegy Ellipta combines three active ingredients - a corticosteroid (fluticasone), an anticholinergic (umeclidinium), and a bronchodilator (vilanterol) - to treat respiratory conditions like asthma and COPD through anti-inflammatory, muscle relaxant, and bronchodilation mechanisms.
  • Symbicort combines a corticosteroid (budesonide) and a long-acting bronchodilator (formoterol) to manage asthma and COPD symptoms by reducing inflammation and relaxing airway muscles.
  • Both Trelegy Ellipta and Symbicort are maintenance medications, not intended for acute asthma attacks, with specific dosage and administration instructions patients should adhere to.
  • Common side effects of both medications include flu-like symptoms, while serious side effects necessitating medical attention include breathing issues, chest pain, blurred vision, tremors, and signs of hormonal disorders.
  • The CAPTAIN trial demonstrated Trelegy Ellipta's efficacy in improving lung function compared to Breo over 24 weeks in asthma patients.
  • The Novel START trial showed Symbicort Turbuhaler reduced annual asthma exacerbations by 51% compared to albuterol alone as an anti-inflammatory reliever therapy.
  • Trelegy Ellipta costs around $323 for 28 powder units, while Symbicort inhalation aerosol costs $289 for 6 grams, but both offer patient assistance programs and copay savings.
  • Prescription savings services like Cuverd® use smart search technology to find the best pricing on medications like Trelegy Ellipta and Symbicort.

1. Mechanism of Action

Trelegy Ellipta and Symbicort tackle respiratory conditions like asthma by targeting inflammation, airway muscles, and breathing passageways. Let's take a closer look at how these two medications work.

Trelegy Ellipta

Trelegy Ellipta combines three active ingredients: fluticasone, umeclidinium, and vilanterol.

Fluticasone is a corticosteroid that helps reduce inflammation in the airways. Umeclidinium is an anticholinergic, which means it acts to relax the muscles around the airways. Vilanterol, on the other hand, is a bronchodilator that widens the airways, making breathing easier.

Together, these components work synergistically to address various aspects of respiratory issues. Fluticasone tackles inflammation, umeclidinium helps with muscle relaxation, and vilanterol provides bronchodilation, collectively improving breathing in chronic obstructive pulmonary disease (COPD) and asthma.

🩺 Doctor’s Note

Trelegy Ellipta is not intended for use during acute bronchospasm or asthma attacks.


Symbicort combines budesonide and formoterol. Budesonide is a corticosteroid that reduces inflammation, similar to fluticasone in Trelegy Ellipta. Formoterol, like vilanterol, is a long-acting bronchodilator that relaxes the muscles in the airways.

The combination of budesonide and formoterol addresses inflammation and provides bronchodilation to manage asthma and COPD symptoms.

2. Dosage and Administration

To fully realize the benefits of Trelegy Ellipta and Symbicort, following prescriber instructions for dosage and administration is critical. Here is some key information on the proper usage of these medications.

Trelegy Ellipta

The typical adult dose of Trelegy Ellipta for asthma involves inhaling one dose (fluticasone/umeclidinium/vilanterol 100 mcg-62.5 mcg-25 mcg) orally once a day.

It is crucial to adhere to the prescribed dosage and not exceed one inhalation every 24 hours. Patients transitioning from systemic corticosteroid therapy should exercise caution, and a gradual tapering of oral corticosteroids may be necessary.

Additionally, individuals using Trelegy Ellipta should not consider it a rescue medicine for asthma attacks. Fast-acting inhalation medications should be used for acute attacks.

Regular medical check-ups and potential adjustments to the dosage may be required based on factors such as:

  • Surgery
  • Illness
  • Stress
  • Worsened asthma

Proper storage, following the provided patient instructions, and discarding the inhaler device after a designated period are also essential.


For Symbicort, the dosage varies based on the severity of asthma and the individual's response to treatment. Typically, the medication controls and prevents asthma symptoms in adults and children 6 years and older. The user should follow the directions on the prescription label and the provided medication guides.

Like Trelegy Ellipta, Symbicort is not intended for treating acute asthma or bronchospasm attacks. It is primarily a maintenance medication. If asthma is well-controlled, a healthcare provider may advise discontinuing Symbicort use.

The inhaler device comes with specific instructions for priming and cleaning, and patients are encouraged to rinse their mouths after each use.

3. Efficacy in Treating Asthma

In addition to understanding how Trelegy Ellipta and Symbicort work, examining research on their real-world efficacy provides valuable insight. Key asthma studies reveal these medications' ability to boost lung function and prevent attacks.

Trelegy Ellipta

Trelegy gained approval for asthma based on the Phase III CAPTAIN study. This trial demonstrated significant improvements in lung function, measured by the change in trough forced expiratory volume over one second (FEV1) at 24 weeks.

When compared to Breo (fluticasone furoate/vilanterol) 100/25 mcg, Trelegy Ellipta 100/62.5/25 mcg showed a substantial 110 mL improvement in FEV1, while the 200/62.5/25 mcg strength displayed a 92 mL improvement compared to Breo 200/25 mcg.

The safety profile of Trelegy was consistent with individual component profiles, with common side effects including cold symptoms, headache, upper respiratory tract infection, and bronchitis.


Symbicort Turbuhaler has been extensively studied in the Novel START trial, a 52-week pragmatic trial conducted by the Medical Research Institute of New Zealand. This trial aimed to assess the efficacy of Symbicort Turbuhaler as an anti-inflammatory reliever as needed in adults with mild asthma.

The trial included 668 patients aged 18-75 across Australia, Italy, New Zealand, and the UK. Patients with mild asthma were randomized to receive either albuterol (a short-acting beta2-agonist reliever) taken as-needed, budesonide (an inhaled corticosteroid maintenance treatment) plus albuterol as-needed, or Symbicort Turbuhaler used as an anti-inflammatory reliever therapy taken as-needed.

The primary outcome measurements revealed that Symbicort Turbuhaler demonstrated a significant 51% reduction in the rate of annual asthma exacerbations compared to albuterol alone. The absolute rate of exacerbations was 0.195 per patient per year with Symbicort Turbuhaler, as opposed to 0.400 with albuterol alone.

Notably, there was no significant difference in the exacerbation rate between Symbicort Turbuhaler as-needed and maintenance budesonide plus as-needed albuterol. Despite this, there was a 52% reduction in the mean steroid dose with Symbicort Turbuhaler compared to maintenance budesonide plus as-needed albuterol.

The safety and tolerability data for Symbicort Turbuhaler were consistent with the known medicine profile. The trial's most commonly reported adverse events included upper respiratory tract infection, nasopharyngitis, and asthma.

4. Side Effects

While Trelegy Ellipta and Symbicort aim to improve breathing, users may experience specific side effects ranging from mild to serious. Being informed on potential reactions can help guide safe and effective treatment.

Trelegy Ellipta

Users of Trelegy Ellipta may experience a range of side effects, and it's essential to be aware of both common and more serious reactions.

Common side effects include cold or flu symptoms such as:

  • Runny or stuffy nose
  • White patches in the mouth or throat
  • Sore throat
  • Cough

Lung infections, nausea, vomiting, joint pain, headache, and changes in taste may also occur.

More serious side effects requiring immediate medical attention include signs of an allergic reaction, such as:

Other serious side effects include:

  • Tremors
  • Chest pain
  • Fast or pounding heartbeats
  • Painful or difficult urination
  • Blurred vision
  • Symptoms indicative of a hormonal disorder

Patients should promptly report any worsening of breathing problems, unusual symptoms, or concerns about medication efficacy to their healthcare providers.


Similarly, Symbicort users may experience common side effects such as:

  • Throat pain or irritation
  • White patches in the mouth or throat
  • Stomach discomfort
  • Vomiting
  • Back pain
  • Headache
  • Flu-like symptoms

Serious side effects that necessitate immediate medical attention include:

  • Worsened breathing problems
  • Sores or white patches in the mouth and throat
  • Tremors
  • Chest pain
  • Fast or pounding heartbeats
  • Cough with mucus
  • Wheezing
  • Blurred vision

High blood sugar, low potassium levels, and signs of a hormonal disorder are also considered serious side effects.

5. Cost

Affordability plays a major role in medication access like Trelegy Ellipta and Symbicort. Cost-saving resources can make these treatment options more attainable for patients.

Trelegy Ellipta

The cost for Trelegy Ellipta inhalation powder (100 mcg-62.5 mcg-25 mcg/inh) is approximately $323 for a supply of 28 powder units. This price is for cash-paying customers and may vary depending on the pharmacy. However, patients have access to various cost-saving options.

Printable coupons, copay cards, and rebates, such as the Discount Card, can save up to 80% or more of the prescription cost. Additionally, eligible commercially insured patients may benefit from a co-pay coupon, potentially paying $0 for a 30/60/90-day supply with a maximum savings of up to $200 per month, and this offer is valid for up to 12 uses until December 31, 2023.

Various patient assistance programs, like those offered by the Patient Access Network Foundation (PAN) and GSK, support low-income or uninsured individuals.


Symbicort, which has a generic version available, comes in an inhalation aerosol form (160 mcg-4.5 mcg/inh). Symbicort inhalation aerosol costs approximately $289 for a supply of 6 grams. Like Trelegy Ellipta, Symbicort offers printable coupons and discounts through the Discount Card.

Patient assistance programs, such as those provided by PAN, offer support to eligible individuals.

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Wrap Up

Trelegy Ellipta and Symbicort are effective maintenance treatments for managing asthma symptoms and reducing exacerbations. Trelegy Ellipta combines three active ingredients to target inflammation, airway muscles, and bronchodilation. In contrast, Symbicort contains two components focused on reducing inflammation and relaxing airways.

While side effects are possible with both medications, they generally have favorable safety profiles. Clinical trials like CAPTAIN and Novel START demonstrate these inhalers' ability to improve lung function and prevent attacks.

Choosing between the two options depends on factors like efficacy for an individual patient, side effect tolerance, age, administration preferences, insurance coverage, and affordability.

FAQs on Trelegy Ellipta and Symbicort

Can you take Symbicort and Trelegy Ellipta together?

No, Symbicort and Trelegy Ellipta should not be taken together. Trelegy already contains two bronchodilators and inhaled steroids, so taking Symbicort with it increases the risk of side effects.

What precautions should you take with Trelegy and Symbicort?

Do not use either drug if you have a severe hypersensitivity to milk proteins or any ingredients. Use caution if you have liver, infections, or eye problems like glaucoma or cataracts. Moreover, rinse your mouth thoroughly after using the medication to reduce the risk of oral thrush. Inform your doctor of any medical conditions.

What types of inhalers are used for Trelegy Ellipta and Symbicort?

Trelegy Ellipta uses a dry powder inhaler called Ellipta. Symbicort is available as a metered-dose inhaler (MDI) and a dry powder inhaler.