Single Maintenance and Reliever Therapy (SMART) for Pediatric Asthma

Asthma is a commonly occurring pediatric condition managed in primary care. In 2020, asthma guidelines changed for treating mild persistent asthma. Now, experts recommend using Single Maintenance and Reliever Therapy (SMART) in children 4 years of age and older. With the SMART approach, patients use one inhaler to maintain and relieve symptoms, as the name implies. The combination inhaler contains budesonide, an inhaled corticosteroid (ICS), and formoterol, a long-acting beta-2 agonist (LABA). The most common brand name associated with this regimen in the United States is Symbicort. While there are various options for ICS therapy, formoterol is currently the sole LABA recommended for use in SMART. SMART is shown to decrease oral steroid use, increase growth rate, reduce emergency department visits and hospitalization, and improve overall asthma control. Although these benefits exist with SMART, there are associated challenges, which include a lack of provider adoption, financial constraints, and a lack of FDA approval for this indication. Despite these challenges, SMART care is efficient and symptom-altering and should be the standard of care for those with persistent asthma.