SMART Reduces Asthma Exacerbation Risk

Use of long-acting β-agonists (LABAs) as both the controller and quick relief therapy in patients with persistent asthma is associated with better clinical outcomes than conventional treatment, according to the results of a recent study.

It has been hypothesized that combination long-acting β-agonists and corticosteroids could provide faster, more effective symptom relief than short-acting β-agonists in patients with persistent asthma.

In order to test the effectiveness of combined use of inhaled corticosteroids and LABAs as controller and quick relief—termed “single maintenance and reliever therapy” (SMART)—researchers conducted a systematic review and meta-analysis of data from 16 randomized clinical trials including 22,748 patients. The trials evaluated SMART vs inhaled corticosteroid with or without LABA used as the controller and short-acting β-agonists (SABA) as relief therapy in patients with persistent asthma.

In patients 12 years and older (mean age 42 years), SMART was linked to a reduced risk of asthma exacerbations compared with same-dose inhaled corticosteroids and LABA, higher-dose inhaled corticosteroids and LABA, and corticosteroids alone as controller therapy. Among patients 4 to 11 years old, SMART was associated with reduced risk of exacerbation compared with higher-dose inhaled corticosteroids and same-dose inhaled corticosteroids and LABA as controller therapy.

“This systematic review supports the combined use of inhaled corticosteroids and LABA as both the controller and quick relief therapy among patients aged 12 years or older compared with using either the same or a higher dose of inhaled corticosteroids alone as the controller therapy or the same or a higher dose of inhaled corticosteroids and LABA as the controller therapy with SABA as the quick relief therapy for patients aged 12 years or older with persistent asthma," the researchers concluded.

—Michael Potts

Reference:

Sobieraj DM, Weeda ER, Nguyen E, et al. Association of inhaled corticosteroids and long-acting β-agonists as controller and quick relief therapy with exacerbations and symptom control in persistent asthma [published online March 19, 2018]. JAMA. doi:10.1001/jama.2018.2769

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