Only 14.5 percent of adult patients with moderate or severe asthma are prescribed the recommended SMART combination inhaler regimen and over 40 percent of academic pulmonary and allergy clinicians have not adopted this optimal therapy, according to research published at the ATS 2024 International Conference. By 2021, both the National Asthma Education and Prevention Program and Global Initiative for Asthma had updated their guidelines to recommend the use of a Single combination corticosteroid (ICS) and formoterol (a long acting beta agonist) inhaler for both Maintenance And Relief Therapy for moderate to severe asthma, or SMART.
In the United States, ICS-formoterol inhalers include Symbicort (budesonide-formoterol) and Dulera (mometasone-formoterol). Under the SMART guidelines, these inhalers are used as both maintenance, twice every day, and rescue inhalers, used during asthma attacks. SMART has been shown to significantly reduce asthma exacerbations.
Previous guidelines recommended the use of maintenance inhalers such as those that combine ICS and a long-acting beta agonist (LABA), generally used twice a day, in addition to short-acting rescue inhalers (bronchodilators such as albuterol). There has been limited data to describe the use of SMART following the update in asthma management guidelines, with no data on the implementation of SMART using administrative or electronic medical records in the United States to the best of our knowledge." Zoe Zimmerman, BS, first author.