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The latest asthma guidelines recommend inhaled corticosteroid (ICS)-formoterol combinations for single maintenance and reliever therapy (SMART). Addressing barriers can increase SMART adoption for better persistent asthma management.

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Area of Science:

  • Pulmonology
  • Pharmacology
  • Clinical Practice Guidelines

Background:

  • Persistent asthma requires effective long-term management strategies.
  • Current guidelines advocate for a shift towards simplified treatment regimens.
  • Inhaled corticosteroid (ICS)-formoterol combinations offer a novel approach.

Purpose of the Study:

  • To review the rationale and evidence supporting Single Maintenance and Reliever Therapy (SMART) for asthma.
  • To identify barriers to the widespread adoption of SMART in the United States.
  • To discuss strategies for overcoming these obstacles.

Main Methods:

  • Literature review of studies on ICS-formoterol combinations for asthma.
  • Analysis of current US clinical practice and guidelines.
  • Identification and categorization of barriers to SMART implementation.

Main Results:

  • Evidence supports SMART for reducing asthma exacerbations and improving control in adolescents and adults.
  • Barriers include lack of FDA approval for SMART indication, inconsistent insurance coverage, and limited available ICS-formoterol combinations.
  • SMART represents a significant change in asthma management paradigms.

Conclusions:

  • SMART is a promising approach for persistent asthma management.
  • Addressing regulatory, financial, and formulary barriers is crucial for wider adoption.
  • Increased provider awareness and implementation strategies can enhance SMART utilization in the US.