SMART singled out for at-risk asthma
Single combination inhaler for maintenance and reliever therapy (SMART) for asthma improves disease control compared with standard treatment in patients at high risk of exacerbations, show the results of two studies published in The Lancet Respiratory Medicine.
Dr Mitesh Patel (Medical Research Institute of New Zealand, Wellington) and colleagues found that treatment with budesonide-formoterol inhaler in a SMART regime almost halved the rate of severe exacerbations in comparison to the same inhaler given as fixed-dose maintenance with salbutamol reliever therapy.
Patients in the SMART group (n=151) had a rate of severe exacerbations comparable to that usually seen in patients with mild asthma (relative rate 0.54 vs standard therapy [n=152]) and significantly fewer high-medication-use days than patients in the standard group (mean 5.1 vs 8.9 days) over 24 weeks. SMART also led to both better adherence and reduced medication overuse compared with standard therapy.
And while patients in the SMART group were exposed to more inhaled corticosteroids this was countered by their lower use of oral corticosteroids, resulting in overall systemic corticosteroid exposure comparable to the standard treatment group.
Meanwhile, Professor Klaus Rabe (Christian Albrechts University Kiel, Germany) and colleagues confirm that beclometasone-formoterol treatment can also be used in the SMART regimen.
In a study of 1701 patients with a history of severe exacerbations, SMART was associated with a significantly increased time to first exacerbation compared with standard treatment (209 vs 134 days) and a 36% reduction in risk of severe exacerbations (12 vs 18%).
Writing in a linked comment, Dr René Aalbers of Martini Hospital in Groningen, the Netherlands, describes the studies as "convincing". However, he cautions that more research is needed to determine which treatment is best for individual patients.
Medical News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Kirsty Oswald, medwireNews Reporter