What is an alternative to Zenhale? A Guide to Maintenance Asthma Medications

October 9, 2025 •

4 min read

According to the European Medicines Agency, the marketing application for Zenhale, a combination asthma medication containing mometasone and formoterol, was voluntarily withdrawn in 2010 due to unresolved issues. Similarly, its U.S. equivalent, Dulera, has been discontinued, leading many to wonder: What is an alternative to Zenhale? This guide explores suitable replacement inhalers for long-term asthma control.

Quick Summary

Several combination inhalers can serve as alternatives for persistent asthma management. Key options include Symbicort/Breyna, Advair/Wixela Inhub, and Breo Ellipta, which combine an inhaled corticosteroid with a long-acting bronchodilator to reduce inflammation and keep airways open. The best choice depends on individual needs, delivery device preference, and specific health factors, and should always be discussed with a healthcare provider.

Key Points

Zenhale Discontinuation: Zenhale (and Dulera) are combination inhalers that are no longer widely available, prompting the need for alternatives.
Combination Inhalers: The primary alternatives are other ICS/LABA combination inhalers like Symbicort/Breyna, Advair/Wixela Inhub, and Breo Ellipta.
Ingredient Differences: While all are ICS/LABA combinations, they contain different specific steroids (mometasone vs. budesonide vs. fluticasone) and LABAs (formoterol vs. salmeterol vs. vilanterol).
Generic Options: Generic versions like Breyna (for Symbicort) and Wixela Inhub (for Advair) offer potentially lower-cost alternatives.
Consult a Doctor: It is critical to work with a healthcare provider to choose an alternative and transition safely, as abruptly stopping a controller medication is dangerous.
Consider Triple Therapy: For more severe or difficult-to-control asthma, a triple-combination inhaler like Trelegy Ellipta may be an option.

Understanding Zenhale and Its Withdrawal

Zenhale was a combination inhaler, specifically a metered-dose inhaler (MDI), that contained two active ingredients: mometasone furoate and formoterol fumarate. Mometasone is an inhaled corticosteroid (ICS) that works to reduce inflammation in the airways, while formoterol is a long-acting beta-agonist (LABA) that relaxes the muscles around the airways to keep them open. This dual mechanism made it an effective maintenance treatment for persistent asthma. Its discontinuation in some markets, and that of its U.S. counterpart Dulera, was due to business and regulatory factors, not safety concerns, but it necessitates a switch for those who relied on it.

Key Alternative Combination Inhalers

The most direct alternatives to Zenhale are other combination inhalers that pair an ICS with a LABA. These medications function similarly by addressing both inflammation and muscle constriction in the airways. The specific components, delivery devices (e.g., dry powder inhaler vs. metered-dose inhaler), and dosing frequency can differ, making consultation with a healthcare professional crucial.

1. Symbicort (budesonide/formoterol)

Active Ingredients: Budesonide (ICS) and formoterol (LABA).
Delivery Device: Dry powder inhaler (DPI), available in both brand-name and generic (Breyna) forms.
Uses: Approved for both asthma (ages 6 and up) and chronic obstructive pulmonary disease (COPD).
Key Advantage: Contains the same LABA (formoterol) as Zenhale. Its generic version, Breyna, offers a potentially more affordable alternative.

2. Advair (fluticasone/salmeterol)

Active Ingredients: Fluticasone (ICS) and salmeterol (LABA).
Delivery Device: Available as a dry powder inhaler (Diskus) or a metered-dose inhaler (HFA), both with generic versions (Wixela Inhub is a generic Diskus).
Uses: Approved for both asthma (ages 4 and up for Diskus) and COPD.
Key Advantage: A very common and long-established alternative with both MDI and DPI delivery options and generic availability.

3. Breo Ellipta (fluticasone/vilanterol)

Active Ingredients: Fluticasone (ICS) and vilanterol (LABA).
Delivery Device: Dry powder inhaler (DPI).
Uses: Approved for asthma (ages 5 and up) and COPD.
Key Advantage: Offers convenient once-daily dosing.

4. Trelegy Ellipta (fluticasone/umeclidinium/vilanterol)

Active Ingredients: A triple combination of an ICS (fluticasone), a long-acting muscarinic antagonist (LAMA - umeclidinium), and a LABA (vilanterol).
Delivery Device: Dry powder inhaler (DPI).
Uses: Approved for more severe asthma and COPD in adults.
Key Advantage: For those with more difficult-to-control asthma, a triple therapy approach can offer superior control.

Choosing the Right Alternative: Factors to Consider

When transitioning from Zenhale, several factors come into play. Your healthcare provider will help you weigh these to find the most suitable option.

Active Ingredients: Your previous response to the specific components in Zenhale (mometasone and formoterol) is a factor. Your doctor may prefer to switch you to an alternative with the same LABA (formoterol, as in Symbicort/Breyna) or explore a different combination.
Delivery Method: If you were using the Zenhale MDI, you might have a preference for another MDI like Advair HFA, or your doctor might guide you on how to use a DPI effectively.
Cost and Insurance Coverage: Brand-name inhalers can be expensive. Alternatives with generic versions, such as Symbicort (Breyna) and Advair (Wixela Inhub), may offer significant cost savings. Check your insurance formulary for covered options.
Dosing Frequency: If convenience is a priority, Breo Ellipta offers once-daily dosing compared to the twice-daily schedule of many other combination inhalers.

Comparison of Key Combination Inhalers


Inhaler (Active Ingredients)	Delivery Device	Generic Version Available	Dosing Frequency	Approved for COPD?	Key Features
Symbicort (budesonide/formoterol)	DPI	Yes (Breyna)	Twice daily	Yes	Contains the same LABA as Zenhale. Generic option for affordability.
Advair (fluticasone/salmeterol)	DPI (Diskus), MDI (HFA)	Yes (Wixela Inhub, etc.)	Twice daily	Yes (Diskus)	Multiple delivery forms and generics widely available.
Breo Ellipta (fluticasone/vilanterol)	DPI	No	Once daily	Yes	Convenient once-daily dosing for better adherence.
Trelegy Ellipta (triple therapy)	DPI	No	Once daily	Yes	Triple-action for severe or hard-to-control asthma.

Transitioning Safely

It is imperative to work closely with a healthcare provider when switching maintenance inhalers. Never abruptly stop taking a medication like Zenhale without a doctor's guidance, as this can lead to a worsening of asthma symptoms. The provider will create a safe transition plan to ensure continuous asthma control. The transition is also an opportunity to review and update your overall asthma action plan, including the use of rescue inhalers for sudden symptom relief. For further information and resources on managing asthma and medication options, consider visiting the Allergy & Asthma Network at https://allergyasthmanetwork.org/.

Conclusion

While the discontinuation of Zenhale (and Dulera) presents a change for many individuals, there are several effective and well-established alternative combination inhalers available. Medications like Symbicort (Breyna), Advair (Wixela Inhub), and Breo Ellipta offer comparable approaches to long-term asthma management by combining an inhaled corticosteroid and a long-acting bronchodilator. For more severe cases, a triple-therapy inhaler such as Trelegy Ellipta may be an option. Consulting with a healthcare provider is the essential first step to determine the most appropriate and safest alternative based on your medical history, current needs, and preferences.

Frequently Asked Questions

Zenhale was the brand name for a combination inhaler containing mometasone and formoterol. In some regions, like the EU, its marketing application was withdrawn. In the U.S., its equivalent, Dulera, has also been discontinued due to business reasons, requiring patients to find alternatives.

Yes. While Zenhale (Dulera) does not have a generic, some of its primary alternatives do. For example, Breyna is the generic version of Symbicort, and Wixela Inhub is a generic version of the Advair Diskus.

Yes, Breo Ellipta is a combination ICS/LABA inhaler and is a potential alternative to Zenhale. A key difference is that Breo Ellipta is dosed once daily, while Zenhale was typically twice daily. As with any switch, you must consult your doctor to determine if it is right for you.

The best alternative depends on your specific medical needs, prior medication responses, delivery device preference (MDI vs. DPI), and insurance coverage. Your doctor will help evaluate these factors to make a recommendation.

Most long-term maintenance inhalers are not designed for rapid relief during an asthma attack. You should always carry a short-acting bronchodilator (SABA) rescue inhaler, such as albuterol, to treat sudden symptoms. The exception is certain formoterol-based combinations when used in a Single Maintenance and Reliever Therapy (SMART) approach, but this must be prescribed by your doctor.

Common side effects for combination ICS/LABA inhalers can include headaches, respiratory infections, and oral thrush. Rinsing your mouth and throat with water after each dose of an inhaled corticosteroid can help prevent thrush.

No. You should never stop your maintenance medication abruptly, even if your symptoms have improved. This can lead to a worsening of your asthma. Any changes to your treatment plan should only be made under the guidance of your healthcare provider.