What is the SMART (Single inhaler Maintenance And Reliever Therapy) method in asthma care?

From the Guidelines

The SMART method in asthma care refers to Single inhaler Maintenance And Reliever Therapy, which involves using a single inhaler for both maintenance and relief of asthma symptoms. This approach is based on the idea of using a combination of medications, such as an inhaled corticosteroid and a long-acting beta agonist, in a single inhaler to provide both long-term control and quick relief of symptoms 1. The goal of SMART is to simplify asthma management and improve patient adherence to treatment, which can lead to better asthma control and reduced risk of exacerbations.

Key Components of SMART

• Using a single inhaler for both maintenance and relief of symptoms
• Combining an inhaled corticosteroid and a long-acting beta agonist in a single inhaler
• Providing patients with clear instructions on how to use the inhaler and adjust their medication as needed
• Monitoring asthma control and adjusting treatment accordingly

Benefits of SMART

• Simplifies asthma management and improves patient adherence to treatment
• Reduces the risk of exacerbations and improves asthma control
• Provides patients with a clear and concise treatment plan
• Can reduce the need for multiple inhalers and medications

Evidence Supporting SMART

Studies have shown that SMART can be an effective approach to asthma management, particularly for patients with mild to moderate persistent asthma 1. A study published in the American Family Physician found that inhaled corticosteroids are the most potent and consistently effective long-term control medication for asthma, and that combining them with a long-acting beta agonist can provide additional benefits 1. Another study found that using a single inhaler for both maintenance and relief of symptoms can improve patient adherence to treatment and reduce the risk of exacerbations 1.

Clinical Application of SMART

In clinical practice, SMART can be applied by prescribing a single inhaler that contains a combination of an inhaled corticosteroid and a long-acting beta agonist, such as fluticasone and salmeterol. Patients should be instructed on how to use the inhaler correctly and how to adjust their medication as needed. Regular monitoring of asthma control and adjustment of treatment can help to ensure that patients receive the best possible care. For example, a patient might use a single inhaler containing fluticasone and salmeterol daily, and have clear instructions to increase their dose if their symptoms worsen or to seek medical attention if their symptoms do not improve.

From the Research

Definition and Purpose of SMART

• The SMART (Single inhaler Maintenance And Reliever Therapy) approach involves using a single inhaler containing a combination of an inhaled corticosteroid (ICS) and a long-acting beta2 agonist (LABA) for both maintenance and reliever therapy in asthma 2, 3.
• The goal of SMART is to provide better control of airway inflammation and prevent asthma exacerbations by administering additional corticosteroids with each reliever inhalation in response to symptoms 2.

Components and Administration of SMART

• The SMART approach typically involves using a combination inhaler containing budesonide and formoterol, with patients taking one or two inhalations twice daily for maintenance and additional inhalations as needed for symptom relief 3.
• The maximum daily dose of formoterol in the SMART approach is typically 54 μg, delivered through a maximum of 12 inhalations per day 3.

Efficacy and Safety of SMART

• Studies have shown that the SMART approach can reduce the odds of severe exacerbations and hospitalizations compared to traditional fixed-dose ICS or ICS-LABA combination therapy 2, 4.
• The SMART approach has also been shown to be effective in reducing asthma symptoms and improving lung function, with a similar safety profile to traditional therapy 2, 3.
• However, some studies have raised concerns about the potential for increased eosinophilia and adverse events with long-term use of the SMART approach 5.

Comparison to Other Treatment Approaches

• The SMART approach has been compared to other treatment approaches, including fixed-dose ICS-LABA combination therapy and regular ICS with as-needed short-acting beta2 agonist (SABA) therapy 2, 4.
• Studies have shown that the SMART approach can be as effective as or more effective than these other approaches in reducing exacerbations and improving asthma control 2, 4.