Several inhalers contain the same type of dual-bronchodilator combination as Anoro Ellipta. Anoro pairs two airway-opening medicines, one that relaxes the muscles around your airways (a LAMA) and one that keeps them open for hours (a LABA), into a single once-daily inhaler for COPD. Four other FDA-approved inhalers use the same LAMA/LABA approach with different active ingredients, and any of them could serve as a comparable alternative depending on your insurance, your comfort with the device, and how often you prefer to use your inhaler.
How Anoro Works
Anoro Ellipta combines umeclidinium and vilanterol. Umeclidinium blocks a receptor on airway smooth muscle called M3, which prevents the signal that tells those muscles to tighten. Vilanterol works on a different pathway, triggering muscle relaxation directly by raising levels of a chemical messenger inside airway cells. Together, they open your airways through two independent mechanisms, which is why dual bronchodilators tend to improve breathing more than either type alone.
You take Anoro once a day through a dry powder inhaler called the Ellipta device. Each dose delivers 62.5 micrograms of umeclidinium and 25 micrograms of vilanterol. The Ellipta requires you to breathe in firmly enough to pull the powder into your lungs, with no need to coordinate pressing a canister and inhaling at the same time.
LAMA/LABA Inhalers Comparable to Anoro
All of the inhalers below treat COPD using the same dual-bronchodilator strategy. They differ in their specific drug ingredients, how many times a day you use them, and what type of device delivers the medicine.
Stiolto Respimat (Tiotropium/Olodaterol)
Stiolto pairs tiotropium (one of the most widely studied LAMAs) with olodaterol, a LABA. It is dosed once daily at 2.5/2.5 micrograms per actuation, with two puffs per dose. The key difference from Anoro is the delivery device. Stiolto uses the Respimat, a soft-mist inhaler that produces a slow-moving aerosol cloud rather than a dry powder. This makes it easier to inhale for people who cannot generate a strong enough breath to use a dry powder device effectively, which is a common issue for patients with severe COPD or older adults with reduced lung capacity.
Bevespi Aerosphere (Glycopyrrolate/Formoterol)
Bevespi combines glycopyrrolate (a LAMA) with formoterol (a LABA) at 9/4.8 micrograms per actuation. Unlike Anoro, it is a twice-daily inhaler delivered through a pressurized metered-dose inhaler (MDI), the familiar canister-and-mouthpiece design. If you’re already comfortable using an MDI, or if you use a spacer, Bevespi may feel more natural. The tradeoff is remembering to take it morning and evening rather than just once a day.
Duaklir Pressair (Aclidinium/Formoterol)
Duaklir combines aclidinium with formoterol at 400/12 micrograms per dose. It is also a twice-daily inhaler, delivered through a dry powder device called the Pressair (known as the Genuair outside the U.S.). The Pressair gives you a color indicator and a click to confirm you inhaled the dose correctly, which some patients find reassuring compared to the Ellipta.
Utibron Neohaler (Glycopyrrolate/Indacaterol)
Utibron pairs glycopyrrolate with indacaterol in a twice-daily capsule-based dry powder inhaler called the Neohaler. You load a capsule into the device before each dose and hear it rattle as you inhale, giving a clear signal that medicine is being delivered. It is dosed at 27.5/15.6 micrograms twice daily. A related formulation of indacaterol and glycopyrronium (marketed as Ultibro Breezhaler in some countries) is dosed once daily at 85/43 micrograms, though availability varies by region.
Once-Daily vs. Twice-Daily Dosing
Anoro, Stiolto, and the Ultibro Breezhaler formulation are all once-daily options. Bevespi, Duaklir, and Utibron Neohaler require twice-daily dosing. Studies comparing once-daily dual bronchodilators in COPD have found similar improvements in lung function across the three once-daily agents. If you’re switching from Anoro primarily because of cost or formulary issues, Stiolto is the closest match in terms of dosing convenience.
Twice-daily inhalers are not less effective, but adherence tends to be better with once-daily regimens simply because there is less to remember. If you already manage a twice-daily medication routine without difficulty, Bevespi or Duaklir are reasonable alternatives.
Device Type Matters More Than You Think
One of the biggest practical differences between these inhalers is how the medicine gets into your lungs. There are three device categories in play:
- Dry powder inhalers (DPI): Ellipta, Pressair/Genuair, Breezhaler, Neohaler, HandiHaler. These require a strong, steady inhalation to pull the powder deep into your airways. No propellant is involved.
- Soft-mist inhaler (SMI): Respimat. Produces a fine mist that travels slowly, making it easier to inhale with less effort. Particularly useful if your breathing is very limited.
- Pressurized metered-dose inhaler (MDI): Aerosphere. Uses a propellant to push the medicine out, so you need to coordinate pressing the canister with your breath. A spacer can help if coordination is difficult.
If you’re switching from Anoro because you struggle with the Ellipta’s dry powder format, choosing a soft-mist or MDI option could improve how much medicine actually reaches your lungs. If the Ellipta works fine for you and you’re switching for other reasons, another DPI like the Breezhaler or Pressair will feel most familiar.
When a Triple Therapy Inhaler Replaces Anoro
Sometimes the question isn’t which LAMA/LABA to switch to, but whether you need to step up to a triple-therapy inhaler that adds an inhaled corticosteroid. Trelegy Ellipta, for instance, contains the same two drugs as Anoro plus an anti-inflammatory steroid, all in the same Ellipta device.
Current COPD treatment guidelines recommend stepping up from a LAMA/LABA to triple therapy if you continue to have flare-ups (exacerbations) and your blood eosinophil count is 100 cells per cubic millimeter or higher. On the other hand, if you’re currently on an inhaled steroid/LABA combination and you haven’t had meaningful exacerbations, switching to a LAMA/LABA like Anoro or one of its alternatives may actually be the better move, letting you drop the steroid you may not need.
Cost and Generic Availability
A generic version of Anoro Ellipta (umeclidinium/vilanterol) has entered the market, though some state Medicaid programs and insurance plans still prefer the brand-name product and price claims accordingly. Whether the generic or brand version is cheaper for you depends entirely on your specific plan’s formulary.
If your insurance doesn’t cover Anoro or its generic, the alternatives above may sit on a different formulary tier. Stiolto and Bevespi are manufactured by different companies with separate pricing structures, so it’s worth checking which LAMA/LABA combination your plan prefers before assuming you need to pay full price for any of them. Your pharmacist can run a formulary check in minutes.