Breo Vs. Trelegy: What Is The Difference?

In our latest question and answer, the pharmacist discusses the difference between two inhalers, Breo and Trelegy.


I have been taken Breo and now my new doctor has changed me to Trelegy. What I want to know is if the side effects are the same for both inhalers?

Asked by jmbowen70 On Mar 05, 2019

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Mar 05, 2019
Breo And Trelegy Side By Side

There are several FDA-approved inhalers for the maintenance and treatment of COPD (chronic obstructive pulmonary disease). Two of the most commonly prescribed are:

  • Breo Ellipta
  • Trelegy Ellipta

Below, I detail the differences between them (including the side effects which you are concerned about).

Breo Vs. Trelegy: Active Ingredients

The main difference between Breo and Trelegy are the active ingredients in both.

Breo contains:

  • Vilanterol
  • Fluticasone furoate

Trelegy contains:

  • Vilanterol
  • Fluticasone furoate
  • Umeclidinium

As you can see, Breo and Trelegy share two of the same active ingredients (vilanterol and fluticasone furoate) but Trelegy contains one additional, umeclidinium. All of these active ingredients are discussed below.


Vilanterol is classified as a long-acting beta-2 adrenergic agonist, or LABA, for short.

It acts on 'beta-2 receptors' in the lungs, which causes the relaxation of smooth muscle in the airways. This relaxation results in increased airflow. Vilanterol acts on the same receptors as albuterol, but is much longer lasting, which is why it is classified as a 'LABA'. Albuterol is known as a SABA (short-acting beta-agonist).

Vilanterol is in both Breo and Trelegy.

Fluticasone Furoate

Fluticasone furoate is a corticosteroid, which acts on many different cells involved in inflammatory pathways. Cells it acts on include:

  • Mast cells
  • Eosinophils
  • Neutrophils
  • Macrophages
  • Lymphocytes

Corticosteroids also act on inflammatory mediators, such as histamine and leukotrienes.

Fluticasone furoate is similar to fluticasone propionate (the active ingredient in Flovent), but binds more strongly to corticosteroid receptors.

Vilanterol is in both Breo and Trelegy.


Umeclidinium is an anticholinergic. It not only causes dilation of the airways muscles (i.e. bronchodilation), but also helps to dry mucus and saliva secretions. The overall result is increased airflow.

Anticholinergics are often used for the treatment of COPD. Aside from umeclidinium, Spiriva (tiotropium) is another commonly used anticholinergic.

Section Summary

Breo and Trelegy both contains vilanterol, a long-acting beta-agonist and fluticasone furoate, a corticosteroid. Trelegy however has a third active ingredient, umeclidinium, an anticholinergic.

Breo Vs. Trelegy: Side Effects

Since Breo and Trelegy contain two of the same active ingredients, side effects are similar. The most commonly reported side effects of both are:

  • Inflammation of the nasal cavities (i.e. nasopharyngitis)
  • Upper respiratory tract infection
  • Headache
  • Thrush infection (due to the corticosteroid fluticasone)
  • Back pain
  • Pneumonia
  • Bronchitis
  • Flu-like symptoms
  • Cough

However, due to the anticholinergic contained in Trelegy, it tends to have a higher incidence of the following side effects:

  • Gastrointestinal (e.g. diarrhea)
  • Dry mouth
  • Dry eyes
  • Altered taste

For both Breo and Trelegy, it is important to rinse your mouth after use to decrease the risk of an oral fungal infection (i.e. thrush).

Section Summary

Breo and Trelegy share similar side effects since they share two of the same active ingredients. The anticholinergic in Trelegy, umeclidinium, can additionally cause gastrointestinal side effects (e.g. diarrhea) as well as dry mouth and dry eyes.

Breo Vs. Trelegy: Use

Breo is FDA-approved for the treatment of asthma and is a first-line recommended treatment for COPD.

Trelegy, on the other hand, is only FDA approved for the treatment of COPD, but only as a second-line option according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.

The GOLD guidelines recommend that 'triple combination products', like Trelegy should be reserved for those who have already tried a two-ingredient product, like Breo. Studies referenced in the GOLD guidelines state that, in these particular individuals, triple combination therapy improves lung function and associated symptoms.

Section Summary

Breo is used for asthma and COPD while Trelegy is a second-line option for COPD only.


About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Office: 716-389-3076

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