Finding the Right Controller Inhaler — What Works for Me

Right now, my daily inhaler is Breztri Aerosphere. I didn’t start there. Like a lot of people with asthma, I’ve been on just about everything over the years. My doctor originally put me on Trelegy Ellipta, which combines three medications—a steroid, a long-acting bronchodilator, and a muscarinic agent. On paper, it made sense, and to be fair, it worked well for controlling my symptoms.

The issue for me wasn’t effectiveness. It was the delivery. Trelegy is a dry powder inhaler, and every time I used it, I felt that blast of powder hit the back of my throat. Sometimes it made me cough, and other times it just felt like I wasn’t getting a full dose. It left me with the feeling that some of the medication wasn’t making it where it needed to go.

Eventually, I asked if I could switch to something different. By that point I was seeing a PA instead of my usual doctor, and she was fine writing a prescription for Breztri. The main difference is that Breztri is a mist inhaler with a propellant. That may not sound like a big deal, but it is. The mist feels smoother going in, and to me it seems like it gets deeper into the lungs. I don’t get that same throat hit, and I don’t feel the urge to cough after using it.

There is a trade-off. Since switching, I’ve noticed more side effects. I get a little jittery at times and have some mild tremors. It’s nothing I can’t tolerate, but it’s definitely more noticeable than what I experienced on Trelegy. My guess is that if more of the medication is reaching my lungs, more of it is also getting into my system, which may explain the difference.

Over time, I’ve also started to pay attention to which parts of these combination inhalers seem to help me the most. Breztri, like Trelegy, contains three types of medication. In theory, they all play a role. But based on my own experience, I’m not convinced they all affect me equally. I’ve used muscarinic drugs going back to atropine years ago and later Atrovent, and I never really noticed much benefit from those.

Steroids are a little harder to judge. I know they’re supposed to reduce inflammation, but I had an experience that made me question how much they help me on their own. When I was on Symbicort, I ended up relying on it more like a rescue inhaler than I should have. My insurance would only allow one inhaler a month, so I would run out during the last week. To get through that gap, my doctor prescribed Flovent. During those stretches when I was only using Flovent, my asthma got worse. The steroid alone didn’t seem to carry me the way the combination inhaler did.

That experience is what led me to believe that the long-acting bronchodilator is the most important part of the combination for me. Having that medication in my system consistently seems to keep my airways open and helps prevent symptoms before they start. I still use my rescue inhaler more often than guidelines recommend, but I also know my asthma is more severe than what’s written in my chart.

At this point, I’ve tried enough different inhalers to know that they all help in their own way. The differences come down to how they’re delivered, how they feel, and how your body responds to them. For me, Breztri works well because I prefer the mist delivery and feel like I’m getting a better dose into my lungs, even if it comes with a few more side effects.

The bigger takeaway is that the “right” inhaler isn’t always the one that looks best on paper. It’s the one you can use consistently and confidently, the one that fits your routine, and the one that actually helps you breathe easier day to day. Right now, for me, that’s Breztri.