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Be SMART About Asthma Management: Single Maintenance and Reliever Therapy.

Alexander F Infante1, Christina Wells1, Julie Loza1

  • 1From the University of Illinois Chicago College of Pharmacy, Department of Pharmacy Practice, Chicago, Illinois (AFI); University of Illinois College of Medicine at Chicago, Chicago, Illinois (CW); University of Illinois College of Medicine at Chicago, Chicago, Illinois (JL); University of Illinois College of Medicine at Chicago, Chicago, Illinois (KH); University of Illinois Chicago College of Pharmacy, Department of Pharmacy Practice, Chicago, Illinois (JBJ); University of Illinois Chicago College of Pharmacy, Department of Pharmacy Practice, Chicago, Illinois (ATE).

Journal of the American Board of Family Medicine : JABFM
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PubMed
Summary

Single maintenance and reliever therapy (SMART) offers an effective asthma management strategy using combined inhaled corticosteroids and long-acting beta-agonists. Avoid short-acting beta-agonist-only treatments and consider SMART for GINA Step 3 or 4 patients, prioritizing budesonide-formoterol.

Keywords:
Anti-Asthmatic AgentsAsthmaEvidence-Based MedicinePharmacotherapyPrimary Health CareSingle Maintenance and Reliever Therapy (SMART)

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Area of Science:

  • Pulmonology
  • Pharmacology

Background:

  • Single maintenance and reliever therapy (SMART) combines inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) for asthma management.
  • Despite guideline adoption, SMART remains a subject of clinical discussion.

Purpose of the Study:

  • To review the evidence supporting SMART.
  • To provide guidance for integrating SMART into comprehensive asthma care.

Main Methods:

  • Review of existing scientific literature and clinical guidelines on SMART.
  • Analysis of evidence for specific ICS/LABA combinations and treatment steps.

Main Results:

  • Short-acting beta-agonist (SABA)-only regimens are not recommended for any asthma severity (SOR A).
  • SMART is recommended for GINA Step 3 or 4 patients, particularly those with adherence issues (SOR B).
  • Budesonide-formoterol is the preferred ICS/LABA combination for SMART (SOR B).

Conclusions:

  • SMART is a valuable approach for moderate-to-severe asthma management.
  • Clinicians should avoid SABA-only therapies and consider SMART for eligible patients.
  • Specific ICS/LABA combinations, like budesonide-formoterol, should be prioritized for optimal outcomes.