Budesonide/formoterol maintenance and reliever therapy; an effective and easy approach to asthma management

Although much progress has been achieved in the treatment of asthma it continues to constitute an important public health problem. Asthma guidelines have been developed to standardize the diagnosis and treatment of asthma worldwide. Studies on asthma control have unfortunately shown that asthma treatment is far from reaching the guideline goals. Recently the Symbicort Maintenance and Reliever Therapy (SMART) approach has gained importance in the control of asthma which suggests the use of a maintenance dose of budesonide/formoterol as well as budesonide/formoterol for relief. Several clinical studies evaluating the new approach have been completed. Use of budesonide/formoterol maintenance + reliever therapy led to a greater reduction in risks of exacerbations than the conventional treatment regimens (higher ICS or similar or higher ICS/LABA) with short-acting beta(2)-agonist and provided similar or better current asthma control compared to high dose ICS/long acting beta(2)-agonist therapy in moderate-severe, uncontrolled, persistant asthma patients. SMART studies also demonstrated that this approach is advantageous in terms of patient compliance since it allows the use of a single inhalation device as both maintenance and rescue therapy; led to lower total healthcare costs and did not differ from the conventional treatment regimens in terms of frequency of side effects. In all the above mentioned studies, mean ICS doses were found to be lower in budesonide/formoterol maintenance and reliever therapy groups than in the comparison groups. Most studies have revealed better asthma control, improved respiratory function tests and reduced oral steroid use at lower ICS doses. SMART approach seems to be promising as a treatment approach that treats both chronic and dynamic increases in inflammation with maintenance and reliever therapy in uncontrolled, moderate-severe persistant asthma patients.