Mild Asthma “Breakthrough” in Australia: Only-Sort-of-Breaking-News

Okay, so I’m not sure if MSN News is just not reporting things clearly, or my Google-Fu skills are failing me, or that maybe—most unfortunately and also most likely—nothing new is really happening.

I watched a video released to MSN News about an an allegedly new method of treating mild asthma (specifically, mild intermittent asthma, typically treated with a rescue inhaler only, such as albuterol/salbutamol, also known as Ventolin) from a team in Australia.

Symbicort Maintenance and Reliever Therapy (SMART)

If you watch the video, you’ll see that no specific drug names are provided, which doesn’t help clarify things any, nor assist my Googling (eventually I found a study enrolment link which also provides no details). What is discussed though is what to me seems like a slight variation on the principles behind Symbicort SMART, which has been available in Europe, Australia, and Canada for a long time, although it is still not available in the U.S. Symbicort Maintenance and Reliever Therapy (SMART) uses the combination inhaler Symbicort as both a maintenance (daily, usually morning and night) and reliever inhaler (as needed). Symbicort contains the inhaled steroid budesonide to decrease inflammation, and the long-acting bronchodilator formoterol to keep airways open for 10-12 hours—unlike salmeterol, the bronchodilator in Advair, formoterol only takes 1-3 minutes to begin working to relieve symptoms (salmeterol takes 15-30 minutes so it should NOT be used for relief of symptoms). SMART makes sense: it is based on the theory that asthmatics who need a long-acting bronchodilator and an inhaled steroid would benefit from increasing their inhaled steroids when their asthma is acting up—ie. when they are needing their rescue inhaler.

Difference between SMART and rescue inhaler

Here’s the only difference between SMART and the method discussed in Australia: SMART is used for both maintenance treatment and relief, so you’d take it morning and night as well as when needed, while the Australian method is used only as needed. So, instead of someone with intermittent asthma going totally without an inhaled corticosteroid as they often do, or taking one when they do not really need to, they get the benefits of both worlds. The researcher interviewed notes that other studies previously literally “taped two inhalers together” which I hope was in the pre-Symbicort days. The research indicates that mild intermittent asthmatics can take a combination of meds only as needed, and experience the same benefits that they might with a daily inhaled steroid and rescue inhaler—all packaged in one inhaler (…or two taped together?). The report stated that reliever therapy with both an inhaled steroid and a bronchodilator still cut the risk of asthma symptoms by 50% for this group of asthmatics—even with only intermittent use.

Here’s what’s interesting to me: it may be an off-label use of sorts, but I have a friend in Israel who kind of figured this out for herself years ago with her doctor. She switched from Advair to Symbicort and loved it, felt better on Symbicort, and then as she was able to decrease her Symbicort, she eventually began using Symbicort as-needed, keeping her Ventolin around for exercise or when she got a cold and the like. And, she’s been doing well using this method ever since, especially as she has the flexibility to take her Symbicort twice a day if needed, such as during dust storms, when hormonal changes affect her breathing, or when she gets sick.

To me, it’s all about options: and if re-purposing an already-in-use inhaler for a slightly different population gives the largest proportion of people with asthma—those with the intermittent form of asthma—I can get behind that. (Even if I’d like for them to come up with a totally new inhaled drug class one of these days!)

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