Barriers to Implementation of SMART: Views From Pediatric Asthma Specialists

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John Paul Jarczyk1, Wayne J Morgan1

  • 1The University of Arizona, Tucson, Arizona, USA.

Pediatric Pulmonology
|December 9, 2025
PubMed

Insights

Pediatric asthma specialists are familiar with Single Maintenance and Reliever Therapy (SMART) but its adoption varies. Improved EMR efficiency and insurance coverage are key to increasing SMART use.

Area of Science:

  • Pediatric Pulmonology
  • Asthma Management
  • Pharmacotherapy

Background:

  • Global Initiative for Asthma (GINA) and National Asthma Education and Prevention Program (NAEPP) guidelines recommend Single Maintenance and Reliever Therapy (SMART) using combination inhaled corticosteroid (ICS)/formoterol inhalers.
  • SMART is recommended to replace short-acting beta-agonists (SABA) as preferred reliever therapy for moderate to severe asthma.
  • The adoption and influencing factors of SMART among pediatric asthma specialists are not well understood.

Purpose of the Study:

  • To investigate the prescribing practices of SMART among pediatric asthma specialists in the United States.
  • To identify factors that facilitate or hinder the implementation of SMART in pediatric asthma care.

Main Methods:

  • An electronic survey was distributed to pediatric pulmonology division directors for dissemination to pediatric asthma specialists.
  • The survey assessed knowledge and practices related to SMART.

Main Results:

  • Sixty-eight responses were analyzed from surveys conducted between March and October 2024.
  • Over 90% of pediatric asthma specialists were familiar with and comfortable implementing SMART.
  • Significant variability in SMART adoption was observed, correlating with region but not clinician comfort or experience.

Conclusions:

  • Despite expert recommendations, substantial variation exists in SMART implementation among pediatric asthma specialists.
  • Pediatric asthma specialists express comfort with SMART, but barriers such as EMR efficiency and insurance coverage need addressing.
  • Enhancing EMR integration and ensuring consistent insurance coverage are crucial for broader SMART adoption.
Abstract

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