Asthma Management with SMART Therapy

Introduction to SMART Therapy

The American College of Allergy, Asthma, and Immunology recommends SMART therapy for asthma management in steps 3 and 4, using a combination of inhaled corticosteroid (ICS) and formoterol in a single inhaler for both daily maintenance and as-needed symptom relief 1, 2

SMART therapy is recommended for patients 5 years and older with persistent asthma not adequately controlled on low-dose ICS alone, as per the American Academy of Allergy, Asthma, and Immunology guidelines 1, 2, 3
Patients experiencing breakthrough symptoms despite regular ICS use may benefit from SMART therapy, according to the American College of Allergy, Asthma, and Immunology 2, 4

For adults and adolescents (≥12 years), the recommended dosing for SMART therapy is low-dose ICS-formoterol, one inhalation once or twice daily for maintenance, plus additional inhalations as needed for symptom relief, as suggested by the American College of Allergy, Asthma, and Immunology 2
For children (5-11 years), the recommended dosing is low-dose ICS-formoterol for maintenance and as-needed relief, with maximum doses being age-appropriate and lower than adult dosing, according to the American Academy of Pediatrics 1, 2

The American College of Allergy, Asthma, and Immunology recommends monitoring the frequency of as-needed use, as increasing use may indicate poor control requiring step-up therapy 3
Assessing control at regular intervals (every 2-6 weeks initially, then every 3 months) is crucial, as per the American College of Allergy, Asthma, and Immunology guidelines 2
Consider stepping down therapy if asthma is well-controlled for at least 3 consecutive months, according to the American College of Allergy, Asthma, and Immunology 2

The American Academy of Allergy, Asthma, and Immunology emphasizes the importance of avoiding LABA monotherapy, as it increases the risk of asthma-related death 5
For children on ICS therapy, monitoring growth is essential, though the benefits typically outweigh risks, as suggested by the American Academy of Pediatrics 5
Alternative approaches for mild asthma, such as as-needed ICS with SABA or as-needed ICS-formoterol, may be considered for step 2 (mild persistent asthma), according to the American College of Allergy, Asthma, and Immunology 2, 4