For many years, asthma treatment involved carrying two separate inhalers: a daily controller inhaler to reduce airway inflammation, and a rescue inhaler to relieve symptoms during an asthma attack.
Today, some people are treated differently using an approach called SMART therapy. SMART stands for Single Maintenance and Reliever Therapy. Instead of using separate controller and rescue inhalers, SMART therapy uses one inhaler for both daily treatment and quick symptom relief. For the right patients, this approach can simplify asthma management while reducing the risk of severe asthma attacks.
How Does SMART Therapy Work?
SMART therapy uses a combination inhaler that contains two medications:
An inhaled corticosteroid (ICS) — this medication reduces inflammation inside the airways over time.
Formoterol — a long-acting bronchodilator (LABA) that begins working quickly to relax the muscles around the airways. Unlike most other long-acting bronchodilators, formoterol starts working within minutes, making it suitable for both daily maintenance and relief of worsening symptoms.
Because the inhaler treats both inflammation and airway narrowing each time it is used, it addresses more than just the immediate symptoms.
Which Inhalers Are Used for SMART Therapy?
SMART therapy requires a combination inhaler that contains an inhaled corticosteroid and formoterol. Examples include inhalers containing budesonide/formoterol and beclomethasone/formoterol (available in some countries).
Not every combination inhaler can be used for SMART therapy. For example, inhalers containing salmeterol or vilanterol are not used as rescue medications because they do not begin working quickly enough. Always use your inhaler exactly as prescribed by your healthcare provider.
How Is SMART Therapy Different?
Traditional asthma treatment: a controller inhaler daily, plus an albuterol rescue inhaler when symptoms occur.
SMART therapy: a combination ICS/formoterol inhaler daily, and the same ICS/formoterol inhaler when symptoms occur. This means patients carry one inhaler instead of two.
What Are the Benefits?
Clinical studies have shown that SMART therapy can reduce severe asthma attacks, lower the need for oral steroids, reduce emergency department visits, improve overall asthma control, and simplify treatment by using one inhaler. Because every additional dose contains an inhaled corticosteroid, worsening inflammation is treated early rather than relying only on a bronchodilator.
Who May Benefit?
SMART therapy may be appropriate for some adolescents and adults with moderate persistent asthma, severe persistent asthma, frequent asthma flare-ups, or repeated rescue inhaler use despite daily controller therapy. Your healthcare provider will determine whether this approach is appropriate based on your symptoms, medical history, and current medications.
Is SMART Therapy Right for Everyone?
No. Some people have asthma that is well controlled with other treatment plans. Others may use inhalers that are not approved or appropriate for SMART therapy. Treatment recommendations depend on asthma severity, age, medication availability, other medical conditions, and current asthma guidelines. Your asthma treatment should always be individualized.
Is SMART Therapy Safe?
For appropriately selected patients, SMART therapy has been shown to be safe and effective when used exactly as prescribed. Using one inhaler for both maintenance and symptom relief may also reduce confusion about which medication to use.
However, it remains important to follow your prescribed dosing instructions, attend regular asthma follow-up visits, review your inhaler technique periodically, and monitor changes in your symptoms.
Do You Still Need an Asthma Action Plan?
Yes. Even with SMART therapy, an asthma action plan remains important. Your plan should explain your usual daily dose, what to do if symptoms worsen, when to seek medical care, and when emergency treatment is needed. Knowing when symptoms require urgent evaluation is just as important as knowing which inhaler to use.
Common Questions About SMART Therapy
Is SMART therapy the same as using albuterol?
No. Albuterol is a rescue medication only. SMART therapy uses a combination inhaler that treats both airway inflammation and airway narrowing.
Can I use any combination inhaler for SMART therapy?
No. Only certain inhalers containing formoterol are appropriate. Never change your inhaler without discussing it with your healthcare provider.
Does SMART therapy replace every rescue inhaler?
For patients whose healthcare provider prescribes SMART therapy, the combination inhaler is typically used for both maintenance and symptom relief. Always follow your individualized asthma action plan.
Can children use SMART therapy?
Some older children and adolescents may be candidates depending on their age, asthma severity, and current treatment guidelines. Your child's healthcare provider will determine the most appropriate treatment plan.
What if my symptoms continue after using my inhaler?
Follow your asthma action plan. If symptoms remain severe or continue to worsen despite your prescribed medication, seek emergency medical care immediately.
When Should You Contact Your Healthcare Provider?
Schedule an appointment if your asthma symptoms are becoming more frequent, you're waking up because of asthma, you're using extra doses more often than expected, your inhaler doesn't seem to relieve symptoms, or you have questions about your asthma action plan. Regular follow-up allows your treatment to be adjusted before symptoms become more severe.
Seek Immediate Medical Care If
Call 911 or seek emergency medical care immediately if you cannot speak in full sentences because of shortness of breath, your lips or fingernails become blue or gray, your breathing rapidly worsens, you become confused or difficult to awaken, or your prescribed asthma medication does not relieve severe breathing difficulty. These symptoms may indicate a life-threatening asthma attack.
The Bottom Line
SMART therapy is a modern asthma treatment strategy that allows certain people to use one inhaler for both daily asthma control and relief of worsening symptoms. By combining an inhaled corticosteroid with the fast-acting bronchodilator formoterol, SMART therapy treats airway inflammation and airway narrowing at the same time.
For many people with moderate to severe asthma, this approach can simplify treatment and reduce the risk of severe asthma attacks. However, it is not appropriate for every patient or every inhaler, so it should only be used under the guidance of a healthcare provider.