What is it about?

This systematic review looked at the impact of utilizing the SMART asthma treatment protocol of low-dose budesonide/formoterol combination with symptom-reactive supplemental dosing. This treatment plan has been reported to reduce exacerbations. We compared this treatment approach to budesonide alone or to lower doses of budesonide/formoterol without supplemental dosing.

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Why is it important?

There is a lack of long-term studies on the impact of the SMART treatment plan despite its broad usage. Our finding found that the SMART plan produces poor day-to-day control of symptoms and is associated with increased inflammation.

Perspectives

This symptom-reactive strategy often results in a concurrent prescription for short-acting bronchodilators and relies on the recognition of poorly controlled asthma. This reactive approach put patients at risk for exacerbations. The SMART strategy should be tested against equivalent or higher doses of budesonide/formoterol given in a symptom-prevention fashion.

Professor Kenneth R Chapman
University of Toronto

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This page is a summary of: The clinical impact of single inhaler therapy in asthma, Clinical & Experimental Allergy, January 2012, Wiley, DOI: 10.1111/j.1365-2222.2011.03928.x.
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