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Studies support combined prevention and rescue asthma inhaler

Two types of common asthma medications combined in one inhaler for both preventive and rescue treatment is more effective at reducing attacks than guideline-based treatment in adults whose asthma is not well controlled, according to two large randomised trials.

The studies also claim that Single inhaler Maintenance and Reliever Therapy, or SMART as it is known, is safe and well tolerated.

Published to coincide with the launch of The Lancet Respiratory Medicine, the research challenges national and international medical guidelines, particularly in the USA, where this approach has yet to be approved.

SMART uses a single ICS/LABA inhaler for both preventive and relief treatment, whereas most adults with asthma are prescribed a corticosteroid (ICS) plus rapid-onset long-acting β2 agonist (LABA) combination inhaler to achieve control along with a second short-acting β2 agonist (SABA) inhaler for rescue use.

The first study investigated a total of 1,714 adults with moderate persistent asthma from 14 European countries. It found that people treated with the SMART beclometasone/formoterol combination had a significantly reduced risk of severe asthma attacks and hospitalisation or urgent medical care compared to those using the current best practice.

The research authors said: “We believe that the additional cost of inhaled corticosteroid and rapid-onset, long-acting β2 agonist combination (29 Eurocents per patient per day) is justifiable because of the significant reduction in severe exacerbations, and specifically hospital admissions, known to have a huge effect on health-care costs in asthma.”

Meanwhile, the second study, the first non-pharmaceutical industry sponsored investigation of its kind, looked at 303 adults aged 16-65 at increased risk of flare-ups and high use of reliever medication.

The researchers from New Zealand reported that the SMART budesonide/formoterol regimen reduced the risk of severe asthma exacerbations. It did this without increasing the risk of beta-agonist overuse or increasing long-term corticosteroid exposure.

In addition, they found that the number of days of high use, marked overuse, and, extreme overuse of beta-agonists were about 40% lower in the group taking SMART compared to the group given standard treatment.

Furthermore, the team revealed that patients prescribed SMART had similar overall systemic corticosteroid exposure because of lower oral corticosteroid exposure use due to reduced severe attacks.

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