Anoro Ellipta alternatives: What can I take instead of Anoro Ellipta?

Compare Anoro Ellipta alternatives | Bevespi Aerosphere | Duaklir Pressair | Stiolto Respimat | ICS/LABA inhalers | LAMA inhalers | Natural alternatives | How to switch meds

Chronic obstructive pulmonary disease, or COPD, is a common lung disease that can greatly lower a person’s quality of life. The medical community has made great efforts in developing inhalers that can reduce the symptoms of COPD and save lives. One commonly used inhaler is called Anoro Ellipta, which is manufactured by GlaxoSmithKline (GSK). Anoro Ellipta is approved for COPD including chronic bronchitis and emphysema. This device delivers two types of medicine: one is called vilanterol, which is a long-acting beta agonist, and the other is umeclidinium, a long-acting muscarinic agent. 

Anoro Ellipta is a very effective inhaler, but it may not be the best for everyone. COPD inhalers come in fixed strengths, making it difficult to tailor doses based on patients’ size and weight. Some inhaler devices are easier to use than others and cause different side effects. Fortunately, many options are available for COPD patients, allowing for greater flexibility. This article will discuss alternatives to Anoro Ellipta, starting with the most similar inhalers.

What can I take in place of Anoro Ellipta?

There are other options available to treat COPD symptoms that do not improve with Anoro Ellipta. These alternative prescription medications include other types of combination inhalers or other classes of respiratory inhalants. These options may be more suitable for certain individuals due to their different indications, side effects, and dosages.

Other alternatives to Anoro Ellipta

ICS/LABA inhalers:

• Breo Ellipta (fluticasone and vilanterol)
• Symbicort (budesonide formoterol)
• Advair HFA (fluticasone and salmeterol inhaled aerosol)
• Advair Diskus (fluticasone and salmeterol inhalation powder)

LAMA inhalers and nebulizer solution:

• Spiriva Handihaler (tiotropium bromide oral inhalation powder)
• Spiriva Respimat (tiotropium bromide oral inhalation spray)
• Incruse Ellipta (umeclidinium oral inhalation powder)
• Tudorza Pressair (aclidinium oral inhalation powder)
• Lonhala Magnair inhalation solution (glycopyrrolate) 

Top 5 Anoro Ellipta alternatives

1. Bevespi Aerosphere

Bevespi Aerosphere, like Anoro Ellipta, is an inhaler that combines two COPD medicines. Bevespi Aerosphere delivers a long-acting beta-agonist (LABA) called formoterol and a long-acting muscarinic agent (LAMA) called glycopyrrolate. LABA and LAMA drugs are called bronchodilators, and both types of bronchodilators can be found in Anoro Ellipta. 

Unlike Anoro Ellipta, Bevespi Aerosphere requires two puffs taken twice daily (every 12 hours), while Anoro Ellipta is just one puff daily. 

Bevespi Aerosphere delivers medicine as a pressurized aerosol spray through a device called a metered-dose inhaler (MDI). These are used a little differently than Anoro Ellipta, which delivers the medicine as a breath-activated dry-powder inhaler (DPI). The biggest difference is that with Bevespi Aerosphere, patients must prime their inhaler and remember to breathe in while they press the button on the inhaler. 

Anoro Ellipta has a longer list of common side effects such as sore throat, sinus infection, and lower respiratory infection, but for the most part, the two inhalers have very similar adverse effects. While both medicines can cause urinary tract infection, it is only listed as a common side effect for Bevespi Aerosphere.

Patients may switch from Anoro Ellipta to Bevespi Aerosphere if they have a hypersensitivity to milk proteins such as lactose. The umeclidinium powder in Anoro Ellipta contains lactose and is contraindicated in patients with severe hypersensitivity to milk proteins. Bevespi does not contain lactose and is a safe alternative in this situation.

2. Duaklir Pressair

The two active ingredients in Duaklir Pressair are formoterol (a LABA) and aclidinium (a LAMA). Thus, Duaklir Pressair is a LAMA/LABA combination inhaler just like Anoro Ellipta and Bevespi Aerosphere. 

Duaklir Pressair is also a dry-powder inhaler (DPI) just like Anoro Ellipta. However, it is taken as one puff every 12 hours, rather than once daily. 

Overall, the possible side effects of Duaklir Pressair are similar to Anoro Ellipta, but the most common side effects are different: they include upper respiratory infection, headache, and back pain. 

Finally, just as in the case of Anoro Ellipta, patients should not use the Duaklir Pressair if they have an allergy to milk proteins because the aclidinium powder contains lactose and may cause a severe reaction.

3. Stiolto Respimat

Stiolto Respimat is another alternative LAMA/LABA inhaler. Its two active ingredients are a LAMA called tiotropium and a LABA called olodaterol. 

Unlike Anoro Ellipta, Stiolto Respimat is a soft mist inhaler (SMI), and it needs to be primed if it has not been used in three days. Patients must breathe in at the same time that medicine is released from the inhaler. 

Like Anoro, this alternative option only needs to be used once a day. However, patients will deliver two puffs per dose instead of one. 

The most common side effects of Stiolto are runny nose, cough, and back pain. Unlike Anoro, Stiolto Respimiat does not commonly cause diarrhea, sore throat, or pain in the extremities. Since Stiolto is within the same class of medicine as Anoro Ellipta, it can still cause some of the less common side effects typical of LAMA/LABA inhalers, including urinary tract infections, urinary retention, tremor, nervousness, heart palpitations, narrow-angle glaucoma, visual disturbances, increased blood pressure, and increased blood sugar.

Patients may switch to Stiolto Respimat if they cannot tolerate Anoro Ellipta due to a milk allergy. Stiolto Respimat does not contain lactose and is a safe alternative in this situation.

4. ICS/LABA inhalers

Certain COPD patients may be able to use an inhaled corticosteroid (ICS) and LABA combination treatment as an alternative to Anoro Ellipta. Examples of inhalers that contain an ICS and LABA include Symbicort, Advair HFA, Advair Diskus, and Breo Ellipta.

According to the National Institute for Health and Care Excellence (NICE) guidelines and Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, a LABA+ICS inhaler can be used in COPD patients with asthmatic features* or features suggesting steroid responsiveness. One example of a steroid-responsive feature would be a high eosinophil concentration. Patients with an eosinophil count of 300 cells/microliter or more may respond better to an ICS/LABA inhaler compared to Anoro Ellipta.

Some patients may benefit from “triple therapy” with an ICS, LABA, and LAMA. These patients can use an ICS/LABA inhaler and a separate LAMA therapy such as Spiriva. For example, they might use a Breo Ellipta inhaler with Spiriva Respimat. Anoro Ellipta would not be a good option for “triple therapy” because it would require an addition of an ICS inhaler and no ICS inhalers are currently approved by the Food and Drug Administration (FDA) for COPD. There are now relatively new inhalers that contain all three drug classes in a single device. These include Trelegy Ellipta and Breztri Aerosphere in the U.S.

* Note: Anoro Ellipta is not for the treatment of asthma. It will not replace not a rescue inhaler, like albuterol, for sudden breathing problems.

RELATED: COPD vs. asthma

5. LAMA inhalers and LAMA nebulizer solution

Not all patients with COPD are started on a combination inhaler like Anoro Ellipta. The GOLD 2021 guidelines on COPD classify patients into four groups based on their disease severity. Patients prescribed a combination inhaler like Anoro Ellipta as their first treatment would fall into Group D. Alternatively, these patients may use a single LAMA inhaler like Spiriva Respimat. Other examples of LAMA inhalers include Spiriva Handihaler, Incruse Ellipta, and Tudorza Pressair. LAMAs are also available as solutions that can be inhaled through a nebulizer device. One example is Lonhala Magnair inhalation solution.

If patients continue to have shortness of breath on a LAMA, treatment should be escalated to a combination inhaler. A LAMA inhaler or LAMA nebulizer solution would not be an appropriate alternative for patients who have shortness of breath while taking Anoro Ellipta. However, in patients new to therapy, a LAMA may be considered as an alternative option.

RELATED: What is a nebulizer?

Natural alternatives to Anoro Ellipta

There are no natural supplements that can replace prescription medications for COPD. However, there are important lifestyle changes that patients can implement alongside their COPD treatment to better manage their symptoms and delay disease progression.

Diet

COPD patients should eat a diet low in saturated fat, rich in fruits, vegetables, and whole-grain foods, and should include regular, small meals instead of one or two large meals. Including a high number of fruits and vegetables in a daily diet is associated with reduced COPD incidence in smokers and ex-smokers. Additionally, the Mediterranean diet has protective effects against developing COPD and is associated with improved lung function in COPD patients, whereas a typical Western diet (high in refined grains, processed and red meat, sugar) increases inflammation.

Weight loss

Maintaining a healthy weight can go a long way towards improving COPD health outcomes. Being overweight or underweight can worsen pulmonary, metabolic, and cardiovascular health. Being underweight leads to muscle loss, low bone mineral density, and nutrient deficiencies, which can all worsen COPD. On the other hand, obese COPD patients have increased shortness of breath at rest and worse health status compared to normal-weight COPD patients.

Exercise

Exercise helps train the body to use oxygen more efficiently, which can also reduce shortness of breath during everyday activities. For patients with mild COPD, even gentle exercise, such as golfing, walking, hiking, and gardening may improve symptoms when done regularly. Moderate to high levels of regular physical activity improve COPD symptoms, prevent lung function decline and reduce COPD exacerbations. However, older adults with mobility limitations must use caution as excessive physical activity may be associated with more frequent respiratory hospitalizations.

Routine vaccinations

Studies have also shown that inactivated flu vaccines reduce flu-associated COPD exacerbations. Studies have also shown that the pneumococcal vaccines reduce the likelihood of COPD exacerbations. Patients with COPD should also ensure that they have been vaccinated against pertussis, as they are at high risk for contracting this bacterial lung infection.

Smoking cessation

Most importantly, patients with COPD who smoke should seek help with quitting immediately. COPD severity caused by smoking is irreversible. Therefore, quitting early is critical to avoid permanent worsening of COPD. Avoiding other lung irritants can also prevent worsening of COPD. These include occupational exposure to vapor, dust, gas, fumes, and particulate matter from air pollution.

RELATED: What happens when you quit smoking?

How to switch to an Anoro Ellipta alternative

Consult a healthcare provider for professional medical advice before making any decision to change therapy for COPD. This includes changes in medicine as well as any change to how medicines are used. Excluding safety issues such as allergic reactions, patients should continue to take Anoro Ellipta until a doctor has approved and prescribed an alternative medication. Providers will assess patients on their ability to use an inhalation device—whether it is an inhaler or a nebulizer—and their ability to adhere to treatments that require multiple doses per day. Physicians who treat lung diseases such as COPD understand the importance of patient preference, access, and cost when it comes to inhaler options. SingleCare offers free coupons for Anoro Ellipta and its alternatives. Many alternatives to Anoro Ellipta are available but each has important advantages or drawbacks. If you desire an alternative option, discuss your needs with a healthcare provider as soon as possible.