Breztri vs Trelegy: Triple Inhalers for COPD and Asthma Compared (2026)

Breztri and Trelegy are the two single-inhaler triple therapies sold in the United States. Each puts three long-term lung medicines into one device: an inhaled steroid, a long-acting beta agonist (LABA) and a long-acting antimuscarinic (LAMA). Both are approved for COPD, and since April 2026 both are approved for asthma as well. They are not interchangeable, though. The drugs are different, the devices are different, one is taken twice a day and the other once, and the US pharmacy cost differs by roughly two to one.

This guide compares them using the current US prescribing information for each product and the trials behind them. It also covers something most comparisons leave out: in asthma, adding the third drug improved lung function in the trials, but neither inhaler significantly reduced asthma attacks compared with a two-drug inhaler. That matters if you are deciding whether a triple is worth it.

The short answer

Breztri Aerosphere (AstraZeneca) contains budesonide, glycopyrrolate and formoterol. It is a pressurised spray inhaler used as 2 puffs twice a day. Trelegy Ellipta (GSK) contains fluticasone furoate, umeclidinium and vilanterol. It is a dry powder inhaler used as 1 inhalation once a day. In COPD, each cut moderate or severe flare-ups by 13% to 25% against two-drug inhalers in its own large trial. No trial has compared the two directly, so neither can be called better on the evidence. In asthma, both raised lung function but did not significantly reduce attacks against the same inhaler without the LAMA.

Question	Breztri Aerosphere	Trelegy Ellipta
Inhaled steroid	Budesonide	Fluticasone furoate
LAMA	Glycopyrrolate	Umeclidinium
LABA	Formoterol	Vilanterol
Device	Pressurised metered dose inhaler (spray)	Ellipta dry powder inhaler
How often	2 puffs twice a day	1 inhalation once a day
COPD	Adults, 160/9/4.8 mcg strength	Adults, 100/62.5/25 mcg strength only
Asthma	Age 12 and over, 160/18/4.8 mcg strength (added April 2026)	Age 18 and over, 100 or 200 strength
US generic	None	None
Rescue use	No	No

What triple therapy means

COPD and asthma treatment is built from three classes of long-acting inhaled medicine. An inhaled corticosteroid (ICS) calms inflammation in the airway lining. A LABA relaxes the muscle around the airways through beta-2 receptors. A LAMA relaxes the same muscle through a different route, by blocking the acetylcholine signal that tightens it. Two-drug inhalers combine either an ICS with a LABA (Symbicort, Advair, Breo) or a LAMA with a LABA (Bevespi, Anoro). A triple inhaler adds the missing class to one of those pairs.

Before single-inhaler triples existed, people took the same three drugs in two separate inhalers. The point of Breztri and Trelegy is fewer devices and fewer steps, which helps people who struggle to use two inhalers correctly. The trials were also large enough to measure what the third drug adds, which is where most of the useful information in this guide comes from.

What changed in 2026

Breztri was first approved in the US for COPD only. The label revision dated April 2026 added maintenance treatment of asthma in people aged 12 and over, a new higher-LAMA strength for asthma (160/18/4.8 mcg per puff), and asthma results from two trials, KALOS and LOGOS. Trelegy has carried an asthma indication for adults since its asthma approval, based on the CAPTAIN trial.

So the old answer to "which triple for asthma" (only Trelegy) no longer holds in the US. The two products now overlap in both conditions, with one difference in age: Breztri's asthma approval starts at 12, Trelegy's at 18. Neither is approved for children under 12.

Doses and strengths compared

Use	Breztri: dose per puff	Breztri: daily dose	Trelegy: dose per inhalation	Trelegy: daily dose
COPD	Budesonide 160 mcg, glycopyrrolate 9 mcg, formoterol 4.8 mcg	2 puffs twice a day (budesonide 640 mcg a day)	Fluticasone furoate 100 mcg, umeclidinium 62.5 mcg, vilanterol 25 mcg	1 inhalation a day
Asthma	Budesonide 160 mcg, glycopyrrolate 18 mcg, formoterol 4.8 mcg	2 puffs twice a day	100/62.5/25 or 200/62.5/25 mcg	1 inhalation a day; 200 strength is the maximum

The Breztri asthma strength doubles the glycopyrrolate per puff and leaves the steroid and LABA unchanged. For Trelegy, only the steroid dose changes between strengths; the 200 strength is not approved for COPD. Neither label allows extra puffs or inhalations: Breztri says no more than 2 puffs twice a day, and Trelegy no more than once every 24 hours.

How you take each one

Breztri is a spray. It has to be primed with 4 sprays before first use, and re-primed with 2 sprays if it has not been used for more than 7 days, after it is dropped, or after the weekly rinse of the actuator. You shake it before each puff and press the canister as you breathe in slowly, which takes coordination. The canister holds 120 puffs, which is 30 days at 4 puffs a day.

Trelegy is a breath-activated powder. You open the cover until it clicks, breathe out away from the mouthpiece, seal your lips and take one long, steady, deep breath, then close the cover. There is no priming and no shaking, but you need enough inspiratory effort to pull the powder in, and you must not breathe into the device. Each inhaler holds 30 doses.

Both labels tell you to rinse your mouth with water and spit it out after each use, to lower the risk of oral thrush from the steroid.

COPD: what ETHOS and IMPACT showed

Breztri's main COPD trial was ETHOS: 8,588 people with moderate to very severe COPD and at least one flare-up in the previous year, treated for 52 weeks. Trelegy's was IMPACT: 10,355 people with COPD and at least one moderate or severe flare-up in the previous year, also over 52 weeks. Each compared its triple with two-drug inhalers made from its own components, in the same device.

Trial and comparison	Flare-ups per year: triple	Flare-ups per year: comparator	Rate ratio (95% CI)	Reduction
ETHOS: Breztri vs glycopyrrolate/formoterol (LAMA/LABA)	1.08	1.42	0.76 (0.69 to 0.83)	24%
ETHOS: Breztri vs budesonide/formoterol (ICS/LABA)	1.08	1.24	0.87 (0.79 to 0.95)	13%
IMPACT: Trelegy vs umeclidinium/vilanterol (LAMA/LABA)	0.91	1.21	0.75 (0.70 to 0.81)	25%
IMPACT: Trelegy vs fluticasone furoate/vilanterol (ICS/LABA)	0.91	1.07	0.85 (0.80 to 0.90)	15%

The pattern is the same in both trials. The triple beat both two-drug options, and the gap was larger against the LAMA/LABA pair (no steroid) than against the ICS/LABA pair. In plain terms, for people with COPD who keep having flare-ups, adding a steroid to two bronchodilators did more than adding a second bronchodilator to a steroid. Severe flare-ups needing hospital care fell by 34% with Trelegy against umeclidinium/vilanterol; against fluticasone furoate/vilanterol the 13% reduction was not statistically significant.

Breztri also had a second COPD trial, KRONOS (1,896 people, 24 weeks), where flare-ups were not required for entry and lung function was the main outcome. There the exacerbation rate ratio was 0.48 (95% CI 0.37 to 0.64) against glycopyrrolate/formoterol and 0.82 (0.58 to 1.17) against budesonide/formoterol. Neither counts as statistically significant under the trial's pre-set testing order, so KRONOS adds little either way on flare-ups.

Why you cannot rank them from these trials

It is tempting to put 0.76 next to 0.75 and call it a tie, or 0.87 next to 0.85 and call Trelegy slightly better. The numbers do not support either reading. The trials enrolled different people (their entry rules for lung function and flare-up history differed), defined flare-ups in slightly different ways, ran in different countries and years, and each compared its triple with its own two-drug inhalers. Both labels caution that adverse reaction rates from different drugs' trials cannot be compared directly, and the same logic applies to efficacy.

Indirect comparisons and observational studies exist, but they cannot settle the question either. The fair summary is that both triples lowered COPD flare-ups against two-drug inhalers by similar amounts in their own trials, and choosing between them comes down to device, dosing schedule, cost and coverage rather than proven difference in effect.

Asthma: lung function went up

The asthma trials asked a narrower question. Everyone was already on a steroid plus LABA and still not controlled. Did adding the LAMA help? Breztri's KALOS and LOGOS trials compared Breztri 160/18/4.8 with budesonide/formoterol in the same device (1,200 and 1,187 people in the efficacy population). Trelegy's CAPTAIN trial (2,436 people analysed) compared each Trelegy strength with fluticasone furoate/vilanterol at the same steroid dose.

Trial	Comparison	Extra trough FEV1 at week 24 (95% CI)
KALOS	Breztri 160/18/4.8 vs budesonide/formoterol	+42 mL (6 to 78)
LOGOS	Breztri 160/18/4.8 vs budesonide/formoterol	+107 mL (68 to 147)
CAPTAIN	Trelegy 100 vs fluticasone furoate/vilanterol 100/25	+110 mL (66 to 153)
CAPTAIN	Trelegy 200 vs fluticasone furoate/vilanterol 200/25	+92 mL (49 to 135)

All four gains were statistically significant. With Breztri, the median time to a 100 mL rise in FEV1 on day one was within 5 minutes in KALOS and LOGOS. Trelegy's label gives about 15 minutes, based on a separate fluticasone furoate/vilanterol trial. The size of the gain varied between Breztri's two trials, from 42 mL in KALOS to 107 mL in LOGOS, which is a reminder that a single trial result can move a lot.

Asthma: attacks did not fall significantly

Lung function is a measurement. What people with asthma usually care about is fewer attacks. On that outcome, both triples fell short of a significant difference against their two-drug comparator.

For Breztri, the label pooled KALOS and LOGOS: the yearly rate of severe asthma exacerbations was 0.54 on Breztri and 0.60 on budesonide/formoterol, a rate ratio of 0.90 (95% CI 0.78 to 1.03). About a third of people in each group had at least one (34% vs 37%). For Trelegy, the label's descriptive pooled analysis of CAPTAIN gave a yearly rate of 0.31 on both Trelegy and fluticasone furoate/vilanterol, a 2.6% reduction with a 95% CI running from 24.9% fewer to 26.2% more.

Asthma control questionnaires were mixed. With Breztri, responder rates were 65% vs 64% in KALOS and 68% vs 64% in LOGOS, neither significant. With Trelegy, the descriptive pooled ACQ-7 responder rate favoured the triple, 63% vs 55% (odds ratio 1.43, 95% CI 1.16 to 1.76). The CAPTAIN authors wrote that adding umeclidinium improved lung function but did not lead to a significant reduction in exacerbations, and that a higher steroid dose did more for exacerbations, especially in people with markers of type 2 inflammation.

What that means if you have asthma

If your asthma is not controlled on a steroid plus LABA, a triple inhaler is one approved next step, and you may feel the extra airway opening. But the trials do not show that the third drug, on average, prevents attacks better than the two-drug inhaler you are already on. Before stepping up, it is worth checking the simpler causes of poor control with your doctor: inhaler technique, missed doses, smoking, allergen exposure, and whether the steroid dose is right. Other options at this step include a higher steroid dose and, for some people with severe eosinophilic or allergic asthma, a biologic.

None of this applies to sudden symptoms. Neither inhaler is a reliever. Keep a fast-acting reliever with you and follow your asthma action plan.

Side effects in the trials

Adverse reaction (ETHOS, 52 weeks)	Breztri (n=2,144)	Glycopyrrolate/formoterol (n=2,125)	Budesonide/formoterol (n=2,136)
Upper respiratory tract infection	5.7%	4.8%	5.4%
Pneumonia	4.6%	2.9%	5.0%
Back pain	3.1%	2.6%	3.0%
Oral candidiasis (thrush)	3.0%	1.1%	2.7%
Influenza	2.9%	2.0%	2.9%
Muscle spasms	2.8%	0.9%	2.5%
Urinary tract infection	2.7%	2.8%	1.9%
Cough	2.7%	2.4%	2.4%

In Breztri's asthma trials, the reactions at 2% or more and more common than with budesonide/formoterol were nasopharyngitis (9.4% vs 8.4%), pneumonia (2.8% vs 2.2%) and headache (2.2% vs 1.2%). Dysphonia (hoarseness) and muscle spasms each ran at about 3% in KRONOS.

Trelegy's label reports its 12-week COPD add-on trials, where headache (4% vs 3%), back pain (4% vs 2%), altered taste (2% vs under 1%) and diarrhoea (2% vs under 1%) were more common with the umeclidinium add-on. In IMPACT, adverse reactions in at least 1% of people over 52 weeks also included upper respiratory tract infection and pneumonia, among others.

Pneumonia: the steroid trade-off in COPD

Inhaled steroids raise the risk of pneumonia in COPD, and both labels carry this as a warning. In ETHOS, confirmed pneumonia occurred in 4.2% on Breztri, 4.5% on budesonide/formoterol and 2.3% on glycopyrrolate/formoterol. There were no fatal pneumonias on the approved Breztri dose. In IMPACT, pneumonia occurred in 8% on Trelegy, 7% on fluticasone furoate/vilanterol and 5% on umeclidinium/vilanterol, with fatal pneumonia in 12 of 4,151 people on Trelegy (0.35 per 100 patient-years) against 5 of 4,134 and 5 of 2,070 on the two-drug inhalers.

The two trials counted pneumonia differently (confirmed vs reported), so the percentages cannot be set side by side. The shared point is that the steroid part of a triple trades fewer flare-ups for more pneumonia, and that the trade is worth it mainly for people who flare up often. Fever, chills, a change in sputum colour or more breathlessness than usual should be reported promptly, because COPD flare-ups and pneumonia can look alike.

Who should not use them

Both labels list two contraindications:

• Primary treatment of status asthmaticus or other acute episodes of COPD or asthma where intensive measures are needed. A triple inhaler is not emergency treatment.
• Allergy to any active ingredient or excipient. Trelegy adds severe hypersensitivity to milk proteins, because the Ellipta powder contains lactose that may carry milk protein.

Neither is approved for children under 12 (Breztri) or under 18 for asthma (Trelegy).

Warnings that matter day to day

• No extra LABA. Do not add another long-acting beta agonist (salmeterol, formoterol, vilanterol, arformoterol, olodaterol) on top. Both labels warn against excessive use.
• No second LAMA. Do not use tiotropium (Spiriva, Tiova, Duova), umeclidinium, glycopyrrolate or any other anticholinergic inhaler alongside a triple. Both labels say to avoid combining anticholinergic medicines, because their side effects add up.
• Coming off steroid tablets. Deaths from adrenal insufficiency have occurred when people moved from steroid tablets to inhaled steroids. Tablets must be reduced slowly under medical supervision, and during illness, injury or surgery you may need extra steroid.
• Getting worse. If you need your reliever more often or it works less well, that is deterioration. Get medical review rather than taking extra triple doses.
• Thrush and hoarseness. Rinse and spit after each dose.
• Narrow-angle glaucoma. The LAMA can worsen it. Eye pain, blurred vision, halos or red eyes need urgent attention.
• Urinary retention. The LAMA can worsen difficulty passing urine, particularly with an enlarged prostate.
• Paradoxical bronchospasm. Wheeze straight after a dose means stop and use your reliever, then seek help.
• Strong CYP3A4 inhibitors such as ritonavir, ketoconazole or clarithromycin can raise steroid levels; both labels advise caution.
• Infections. Inhaled steroids can lower resistance to infection. Chickenpox and measles can be serious or even fatal in people without immunity, so seek advice after any exposure. Tell your doctor about tuberculosis or untreated infections.
• Allergic reactions. Swelling of the face, lips or throat, hives or trouble breathing after a dose need emergency care.
• Bone, eyes and adrenal glands. Long-term inhaled steroids are linked with lower bone density and cataracts. Adrenal suppression is more likely above the recommended dose, with strong CYP3A4 inhibitors, or after switching from steroid tablets.
• Heart rhythm, blood potassium and blood sugar can be affected by the LABA; people with heart disease, seizures, thyroid disease or diabetes need more care.
• Other medicines. Both labels advise extreme caution with MAOIs, tricyclic antidepressants and drugs that prolong the QT interval. Beta blockers can cancel the LABA effect and may cause severe bronchospasm, so they are not normally used in asthma or COPD. Water tablets (loop or thiazide diuretics) can add to potassium loss.

US cost: Breztri is about double

NADAC is the US government's survey of what pharmacies pay to buy a drug. It is not the cash price at the counter, and insurance coverage changes what you pay, but it is a neutral way to compare.

Product	NADAC per unit (week of 7 Oct 2026)	Units for 30 days	30-day cost
Breztri 160/9/4.8 mcg	$61.41 per gram	One 10.7 g canister (120 puffs)	$657.13
Trelegy 100/62.5/25 mcg	$11.12 per inhalation	30 inhalations	$333.48
Trelegy 200/62.5/25 mcg	$11.18 per inhalation	30 inhalations	$335.28

The new Breztri asthma strength (160/18/4.8 mcg) had no NADAC listing at the time of writing. Neither product has a US generic, and both are expensive without coverage. Manufacturer savings programs and plan formularies often decide which one a person ends up on in practice.

Outside the US: Trixeo, Trimbow and Indian triples

In the UK and EU, Breztri is sold as Trixeo Aerosphere and Trelegy keeps its name. A third triple, Trimbow (beclometasone, formoterol and glycopyrronium), is widely used there and has no US approval. In India, Cipla sells Foracort G, a budesonide, glycopyrronium and formoterol spray inhaler at 200/12.5/6 mcg per puff, used as 2 puffs twice a day. Cipla's prescribing information for the Foracort G Rotacaps version states that the safety and efficacy of the combination in asthma have not been established.

Foracort G has the same three molecules as Breztri, but it is not the same product. The strengths may be written on a different basis (salt vs base, and metered vs delivered dose), the formulation and device are different, and ETHOS, KRONOS, KALOS and LOGOS tested Breztri, not Foracort G. Treat it as a separate medicine and do not switch between them without your doctor working out the equivalent dose. Cipla's Triohale (tiotropium, formoterol and ciclesonide) has no FDA-approved equivalent; the only ciclesonide products the FDA lists are single-ingredient. If you are on a LAMA such as tiotropium or a two-drug bronchodilator such as Duova (tiotropium and formoterol), our tiotropium inhaler guide covers that step. These are alternatives to a triple, not add-ons to it.

If you are moving from a two-drug inhaler

Most people come to a triple from an ICS/LABA such as Foracort or Symbicort, or from a LAMA/LABA. When the triple starts, the long-acting two-drug inhaler usually stops, because using both would double the LABA, and any separate LAMA such as tiotropium stops too, because both labels say to avoid combining anticholinergics. Keep your reliever. Our budesonide and formoterol guide and the Advair vs Symbicort comparison cover the two-drug step, and the Seroflo and generic Advair strengths guide explains why the number on a fluticasone/salmeterol box can mislead. Device choice matters as much as molecule choice; see rotacaps vs inhaler vs respules.

Questions to take to your doctor

• How many flare-ups have I had in the last year, and how many needed steroid tablets or antibiotics? Triples showed the most benefit in people who flare up.
• For asthma: have we checked technique, adherence and triggers, and is a higher steroid dose or a biologic a better step than adding a LAMA?
• Can I use a spray reliably (Breztri), or would a once-daily breath-activated powder suit me better (Trelegy)?
• Do I have glaucoma, prostate or bladder problems, or a milk protein allergy?
• What does my plan cover, and is there a savings program?
• What is my plan if I start getting worse? Our guide to prednisolone for asthma flare-ups covers steroid tablet courses.

For more on asthma treatment options, see the asthma hub.

Sources

• BREZTRI AEROSPHERE (budesonide, glycopyrrolate and formoterol fumarate) US prescribing information, AstraZeneca, revised April 2026: sections 1, 2, 4, 5, 6.1, 14.1, 14.2 and 16. DailyMed
• TRELEGY ELLIPTA (fluticasone furoate, umeclidinium and vilanterol) US prescribing information, GSK: sections 1, 2, 4, 5.5, 6.1, 14 and 16. DailyMed
• Rabe KF et al. Triple inhaled therapy at two glucocorticoid doses in moderate-to-very-severe COPD (ETHOS). N Engl J Med 2020. PMID 32579807. PubMed
• Lipson DA et al. Once-daily single-inhaler triple versus dual therapy in patients with COPD (IMPACT). N Engl J Med 2018. PMID 29668352. PubMed
• Lee LA et al. Efficacy and safety of once-daily single-inhaler triple therapy (FF/UMEC/VI) versus FF/VI in patients with inadequately controlled asthma (CAPTAIN). Lancet Respir Med 2021. PMID 32918892. PubMed
• US FDA. Drugs@FDA application records for ciclesonide and for budesonide/glycopyrrolate/formoterol (NDA 212122). FDA
• Cipla. Foracort G inhaler and Foracort G Rotacaps prescribing information. Ciplamed
• Centers for Medicare and Medicaid Services. National Average Drug Acquisition Cost (NADAC), 2026 file, week of 7 October 2026. data.medicaid.gov

This guide is for information only and is not medical advice. Breztri, Trelegy and Foracort G are prescription medicines. Do not start, stop or switch a maintenance inhaler without your prescriber, and always keep a reliever inhaler for sudden symptoms.