A Practical Guide to Implementing SMART in Asthma Management
| Autor: | Michelle M. Cloutier, Michael Schatz, Jerry A. Krishnan, Helen K. Reddel, Eric D. Bateman |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Adolescent medicine.drug_class Mometasone/formoterol immune system diseases Bronchodilator Formoterol Fumarate Administration Inhalation medicine Immunology and Allergy Humans Budesonide Child Asthma business.industry Inhaler medicine.disease respiratory tract diseases Bronchodilator Agents Clinical trial Regimen Drug Combinations Treatment Outcome Budesonide/formoterol Ethanolamines Emergency medicine Formoterol business medicine.drug |
| Zdroj: | The journal of allergy and clinical immunology. In practice. 10(1S) |
| ISSN: | 2213-2201 |
| Popis: | The use of a Single inhaler containing the combination of an inhaled corticosteroid (ICS) and formoterol, a specific long-acting bronchodilator (LABA), for both Maintenance And quick Relief Therapy (SMART, or MART) is recommended by both the Global Initiative for Asthma (GINA) and the National Asthma Education and Prevention Program (NAEPP) Coordinating Committee in Steps 3 and 4 of asthma management. This article provides practical advice about implementation of SMART in clinical practice based on evidence and clinical experience. Fundamental to SMART is that ICS-formoterol provides similarly quick relief of asthma symptoms as short-acting beta2-agonist (SABA) such as albuterol, while reducing the risk of severe asthma exacerbations, at an overall lower ICS exposure. Most SMART clinical trials were in adults and adolescents (≥12 years), using budesonide-formoterol 160/4.5 mcg (delivered dose), 1 inhalation once or twice daily (Step 3) and 2 inhalations twice daily (Step 4). For both Step 3 and 4, patients also take additional inhalations of budesonide-formoterol 160/4.5 mcg, 1 inhalation whenever needed for symptom relief, up to a maximum for adults/adolescents of 12 total inhalations in any single day (delivering 54mcg formoterol). The efficacy and safety of SMART with budesonide-formoterol and beclometasone-formoterol have been confirmed, but other ICS-long-acting bronchodilator combinations have not been studied. The SMART regimen should be introduced with a careful explanation of its role in self-management and preferably with a customized written asthma action plan. The cost to patients and availability of SMART treatment will depend on prescribed dose and national/local payer agreements. |
| Databáze: | OpenAIRE |
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