Hi Liz - Symbicort, (or generic Breyna) is an LABA plus ICS. I will be asking my new pulmonologist if he recommends change to an LAMA.
Breo uses fluticasone, which has been blamed more often for steroid-induced reduced immunity, while Symbicort uses budosenide which I believe is considered a safer long term medicine, but I cannot find the article about it right now.
Long term use of all steroids, oral or inhaled, has risks, so I would like to move on if I can.