SMART for Mild Asthma?
My friend Dia recently sent me a link to a journal article about different treatment options for mild asthmatics. I promise we also discuss normal things like almond milk, popcorn, swimming, and mug cakes. The study could be useful for patients using SMART plan to treat their asthma.
What is SMART?
Single Inhaler for Maintenance And Rescue Therapy (SMART) is available in some countries using an inhaler that combines a long-acting bronchodilator with an inhaled corticosteroid to treat all asthma symptoms.1 This is generally done with an inhaler that combines the budesonide and formoterol like Symbicort.1 Patients are given a maximum number of daily puffs of this single inhaler.1
When you have symptoms on the SMART treatment plan you take additional puffs of Symbicort or the combined inhaler you have been prescribed in lieu of a rescue inhaler.1 As much as I would like to have just one inhaler to carry for all my medication needs this has never been offered to me as a treatment option. I continue to have separate maintenance and rescue inhalers.
A new study comparing SMART treatment to traditional treatment
This study compared two different treatment options for patients with mild asthma. It was a double-blind randomized trial. Patients either received placebo maintenance therapy with a budesonide-formoterol rescue inhaler or a maintenance dose of Budesonide with Terbutaline as a rescue inhaler.2
The study compared rates of severe exacerbation and symptoms as reported by the Asthma Control Questionaire.2 The first treatment option is similar to SMART therapy while the second is the maintenance inhaler + separate rescue inhaler. I am well acquatinted with the latter, as I sit here next to a Ventolin headed for a maintenance inhaler dose in an hour or so.
Results of the study
Results of the study were that the combination inhaler as needed was no worse than a steroid-only maintenance treatment for preventing severe exacerbations.2 Combination inhaler therapy resulted in a lower median daily dose of inhaled steroids.2 “The time to the first exacerbation was similar in the two groups.2” The Asthma Control Quality scores were 0.11 units higher for those in the daily budesonide inhaler group than for those in the combination inhaler group.2
The study concludes that a combination inhaler as needed is noninferior to twice a daily steroid inhaler in preventing exacerbations but inferior for control of symptoms.2 It also notes that as needed combination inhaler therapy results in approximately 1/4 the inhaled steroid exposure of daily maintenance treatment group.2
While I find this study’s results interesting it doesn’t apply directly to me or my current treatment plan. It is a case of science that lacks sensational headlines. These two treatment plans are roughly the same for keeping you out of the hospital. The one with less steroid exposure also has the lower quality of life measures.2
Maybe someday researchers will bring us a treatment option that checks all the boxes. In the meantime, there is one more piece of literature to ask your care team about if you have mild asthma. I wish science was more exciting. Maybe the next study that piques my interest will be.
Have you ever gotten "moon face" as a side effect of prednisone?