Common Brand Names of Inhalers for SMART Protocol
Symbicort (budesonide/formoterol) is the primary inhaler that fits the SMART (Single Maintenance And Reliever Therapy) protocol, as it contains formoterol which has a rapid onset of action necessary for reliever therapy. 1
Understanding SMART Protocol
- SMART protocol involves using a single inhaler containing both an inhaled corticosteroid (ICS) and formoterol (a specific long-acting beta2-agonist with rapid onset) for both daily maintenance therapy and as-needed symptom relief 2, 1
- This approach is recommended by both the Global Initiative for Asthma and the National Asthma Education and Prevention Program Coordinating Committee for steps 3 and 4 of asthma management 1
- SMART is primarily studied and approved for patients 12 years and older 2
Specific Inhalers Compatible with SMART Protocol
- Budesonide/formoterol (Symbicort) - Most extensively studied and the primary inhaler used in SMART protocol 1, 3
- Beclomethasone/formoterol (Foster) - Has also been confirmed effective for SMART protocol 1, 4
- Mometasone/formoterol (Dulera) - Can potentially be used in SMART protocol as it contains formoterol, though less extensively studied than budesonide/formoterol 2
Important Distinctions
- Not all ICS/LABA combinations can be used for SMART protocol:
- Formoterol is the key component that enables the SMART approach due to its rapid onset of action similar to short-acting beta-agonists 2, 1
Dosing Considerations for SMART Protocol
- For adults and adolescents (≥12 years), typical SMART dosing with budesonide/formoterol 160/4.5 μg is:
- Maximum daily limit: 12 total inhalations in any single day for adults and adolescents 1
Clinical Benefits of SMART Protocol
- SMART approach reduces the risk of severe exacerbations compared to fixed-dose regimens 3, 5
- Provides similar or better asthma control with lower overall medication use compared to traditional fixed dosing 3
- Improves airway inflammation and small airway impairment compared to fixed-dose fluticasone/salmeterol 6
Common Pitfalls and Considerations
- Insurance coverage may limit access to multiple inhalers of the same type, creating challenges for implementing SMART protocol 2
- Patient education is crucial - patients must clearly understand which inhaler to use as both maintenance and reliever 2
- SMART is not currently recommended for step 5 treatment in the NAEPP guidelines due to limited high-quality studies, though GINA guidelines suggest continuing this approach 2
- SMART is an off-label use in some regions despite strong evidence supporting its efficacy 2
Remember that while Flovent (fluticasone) is a common inhaled corticosteroid, it is not part of the SMART protocol as it does not contain formoterol or any bronchodilator component 2.