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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
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A Practical Guide to Implementing SMART in Asthma Management.

Helen K Reddel1, Eric D Bateman2, Michael Schatz3

  • 1The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia.

The Journal of Allergy and Clinical Immunology. in Practice
|October 19, 2021
PubMed
Summary
This summary is machine-generated.

Single maintenance and reliever therapy (SMART) uses one inhaler for both asthma maintenance and quick relief. This approach, combining inhaled corticosteroids and formoterol, offers symptom relief while reducing exacerbation risk and overall steroid exposure.

Keywords:
As neededAsthmaBudesonide-formoterolExacerbationsICS-LABAMometasone-formoterolSMART

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Area of Science:

  • Pulmonology
  • Pharmacology

Background:

  • Single maintenance and reliever therapy (SMART) is recommended for moderate to severe asthma management.
  • SMART utilizes a single inhaler containing an inhaled corticosteroid (ICS) and formoterol for both daily maintenance and quick symptom relief.

Purpose of the Study:

  • To provide practical guidance for implementing SMART in clinical settings.
  • To highlight the benefits of SMART, including rapid symptom relief and reduced risk of severe asthma exacerbations.

Main Methods:

  • Review of clinical trials and expert experience with SMART regimens.
  • Focus on budesonide-formoterol 160/4.5 μg in adults and adolescents (≥12 years) for GINA steps 3 and 4.
  • Description of dosing for maintenance and as-needed relief, up to 12 inhalations daily.

Main Results:

  • SMART with ICS-formoterol provides quick relief comparable to short-acting β2-agonists.
  • It effectively reduces severe asthma exacerbations and lowers overall ICS exposure.
  • Efficacy and safety confirmed for budesonide-formoterol and beclometasone-formoterol combinations.

Conclusions:

  • SMART is an effective asthma management strategy for steps 3 and 4.
  • Implementation requires clear patient education on self-management and action plans.
  • Treatment cost and availability depend on prescribed dosage and payer agreements.