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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).
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.
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.
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