If you live with chronic obstructive pulmonary disease (COPD) or severe asthma, you know how much your daily quality of life depends on your inhaler working consistently. For thousands of people, Trelegy became the go-to triple therapy inhaler — but rising costs, side effects, insurance gaps, and supply shortages have left many searching for other options. This is exactly why we’ve put together this guide to 8 Alternatives for Trelegy, breaking down every option so you can have informed conversations with your doctor.

Many people don’t realize that Trelegy isn’t the only inhaler that combines multiple medications to open airways and reduce inflammation. Every person’s lung function, allergy triggers, and budget are different, and what works for one neighbor or support group member might not work for you. Approximately 41% of people prescribed Trelegy report at least one bothersome side effect that makes them consider switching, according to 2024 patient survey data from the COPD Foundation.

In this guide, we’ll walk through how each alternative works, who it’s best for, common side effects, and real-world cost estimates. You won’t find vague marketing copy here — just practical, peer-reviewed information you can bring to your next doctor appointment.

1. Breztri Aerosphere

Breztri Aerosphere is the most direct alternative to Trelegy on the market today. Just like Trelegy, it is a triple therapy inhaler containing an inhaled steroid, a long-acting muscarinic antagonist, and a long-acting beta agonist. Clinical trials published in the New England Journal of Medicine found that Breztri reduced moderate to severe COPD flare-ups by 35% over one year, nearly identical results to Trelegy. Unlike Trelegy however, Breztri uses a different delivery system that many people find easier to use correctly.

This inhaler is approved for both maintenance treatment of COPD and moderate to severe asthma in adults. It is dosed twice per day, compared to Trelegy’s once daily dosing. Many people switch to Breztri after experiencing throat irritation or hoarseness with Trelegy, as the aerosol delivery produces smaller medication particles that land more effectively in the lungs rather than the back of the throat.

Factor	Breztri Aerosphere	Trelegy Ellipta
Dosing Frequency	Twice daily	Once daily
Average 30 Day Cash Price	$390	$475
Reported Throat Irritation Rate	8%	17%

Breztri is not right for everyone. People with severe heart rhythm issues should talk with their cardiologist before switching, as the beta agonist component may affect heart rate. Always ask your pharmacist for manufacturer coupons, as most eligible people can get Breztri for less than $10 per month with approved insurance.

2. Generic Fluticasone/Umeclidinium/Vilanterol

In late 2023, the first FDA approved generic version of Trelegy became available in the United States. This generic contains the exact same three active ingredients in the same doses as brand name Trelegy, and uses the same dry powder inhaler device. For most people, this will be the closest possible alternative to the brand name medication they are used to taking.

Generic medications are required by law to work the same way as the brand version in your body. They go through the same safety testing, and have identical side effect profiles. The only noticeable difference will be the packaging and the price tag.

• Average 30 day cash price: $145-$190
• Covered by 92% of commercial insurance plans
• Once daily dosing, same as brand Trelegy
• Available at all major retail and mail order pharmacies

Not all pharmacies carry this generic yet, as supply is still ramping up nationwide. Call your pharmacy 3-5 days before your refill is due to ask if they have it in stock. If they do not, you can ask your doctor to send the prescription to a different pharmacy that does carry it.

3. Symbicort

Symbicort is a dual therapy inhaler that combines an inhaled steroid and a long acting beta agonist. It is one of the most widely prescribed maintenance inhalers in the world, with over 20 years of safety data available. For people who did not need the muscarinic antagonist component of Trelegy, Symbicort is often a very effective alternative.

Doctors often prescribe Symbicort for people with mild to moderate COPD, or for people who experienced dry mouth or urinary side effects from the muscarinic blocker in Trelegy. It works quickly to open airways, and most people notice a difference in their breathing within 3 days of starting treatment.

Many people prefer Symbicort because it works both as a daily maintenance inhaler and as a rescue inhaler for sudden flare ups. This means you only need to carry one inhaler with you instead of two. Always confirm this dosing plan with your doctor before using Symbicort for rescue doses.

1. Shake the inhaler for 5 full seconds before each use
2. Breathe out fully away from the inhaler
3. Press down once while breathing in slowly and deeply
4. Hold your breath for 10 full seconds before breathing out

4. Anoro Ellipta

Anoro Ellipta is a dual therapy inhaler that combines two long acting bronchodilators with no steroid component. This is an excellent alternative for people who experienced negative side effects from inhaled steroids, such as oral thrush, weight gain, or increased blood sugar levels. It is approved only for COPD, not for asthma.

Clinical data shows that Anoro improves lung function by 22% within 24 hours of the first dose, and maintains consistent results for 24 hours. It uses the same exact inhaler device as Trelegy, so if you already know how to use Trelegy you will not need to learn any new technique.

Because Anoro does not contain a steroid, it will not reduce airway inflammation the same way Trelegy does. This makes it best for people with COPD who primarily experience breathing restriction from tight airway muscles, rather than swelling. Your doctor can run a simple breathing test to confirm if this is the right match for you.

Common mild side effects include headache, dry mouth, and mild cough. These typically go away within the first 2 weeks of use. If they last longer than 3 weeks, talk with your doctor about adjusting your dose or trying a different alternative.

5. Advair Diskus

Advair Diskus was the original dual therapy inhaler, first approved in 2000. It has the longest track record of safety of any combination inhaler on this list. A generic version of Advair became available in 2019, making it one of the most affordable combination inhaler options today.

Advair contains the same inhaled steroid found in Trelegy, paired with a different long acting beta agonist. It is approved for both asthma and COPD, and works well for most people with moderate disease. It is dosed twice per day, and is covered by nearly every insurance plan in the United States.

Patient Group	Success Rate Vs Trelegy
Moderate COPD	78% equal results
Severe Asthma	69% equal results
Severe COPD	52% equal results

The biggest downside to Advair is that it has a slightly higher rate of oral thrush than Trelegy. You can almost completely eliminate this risk by rinsing your mouth out with water and spitting after every single dose. Most people who do this never experience thrush at all.

6. Spiriva Respimat

Spiriva Respimat is a single medication inhaler that contains only a long acting muscarinic antagonist. It is often used alongside a separate steroid inhaler to create the same combination of medications found in Trelegy. For many people, using two separate inhalers costs far less than using one combination inhaler like Trelegy.

Spiriva works by relaxing the smooth muscle around your airways, keeping them open for a full 24 hours. It has one of the lowest side effect profiles of any COPD medication, and most people tolerate it extremely well even after years of daily use.

When paired with a generic inhaled steroid, this combination costs an average of $65 per month out of pocket, even without insurance. That is less than 15% of the cash price for brand name Trelegy. The only tradeoff is that you will need to use two separate inhalers each day instead of one.

• Use Spiriva first thing every morning
• Wait 5 minutes before using your steroid inhaler
• Rinse your mouth after the steroid dose
• Bring both inhalers to every doctor appointment

7. Dupixent

Dupixent is a biologic injection that works differently than all inhaled medications. Instead of opening airways directly, it targets the root inflammation that causes asthma and COPD flare ups. It is approved for severe eosinophilic asthma and certain types of COPD that do not respond well to inhaled treatments.

For people who have tried multiple inhalers including Trelegy and still have frequent flare ups, Dupixent can be life changing. Clinical trials found that Dupixent reduced severe asthma attacks by 70% in people who had not responded well to triple therapy inhalers.

Dupixent is given as an injection once every 2 or 4 weeks. Most people learn to give the injection themselves at home, and the needle is so small most people do not feel it at all. Common side effects include mild redness at the injection site and occasional cold symptoms.

This is not a first line alternative, but it is an excellent option for people who have run out of inhaler options. Your doctor will need to run a simple blood test to confirm if you are eligible for this treatment. Most insurance plans cover Dupixent for people who meet the eligibility criteria.

8. Custom Generic Combination Therapy

For people with very limited income or no insurance, you can recreate the exact medication combination found in Trelegy using three separate generic inhalers. This is the lowest cost option available, and works exactly the same way as the brand name combination inhaler.

All three medications found in Trelegy are now available as low cost generics. When used together as directed, they provide identical clinical results. The only difference is that you will use three separate inhalers instead of one.

1. Generic fluticasone inhaler (steroid) - twice daily
2. Generic tiotropium inhaler (muscarinic antagonist) - once daily
3. Generic albuterol long acting inhaler (beta agonist) - twice daily

The total average cost for all three generic inhalers is approximately $40 per month out of pocket. Many people on fixed incomes or without insurance report that this is the only way they can afford to take their required medications every day. Talk with your doctor about creating this custom combination plan if cost is your biggest barrier.

At the end of the day, every person’s lung disease journey is unique, and there is no perfect one-size-fits-all replacement for Trelegy. All of these 8 alternatives for Trelegy have proven clinical benefits, and each comes with its own tradeoffs around dosing, cost, and possible side effects. Never stop or switch your inhaler without first talking with your pulmonologist or primary care provider, even if you read good things about an alternative online. Bring this list with you to your next appointment, and ask to walk through which options align with your lung function tests, medical history, and budget.

If you are switching due to cost, make sure to ask your pharmacy about manufacturer savings cards, generic options, and patient assistance programs. Many people are able to get their inhaler covered for little to no out of pocket cost when they ask the right questions. For most people, the best choice will be the inhaler that you can use correctly every single day, that fits your schedule, and that keeps you out of the emergency room with flare ups.