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Single inhaler asthma therapy better

Two new studies find single inhaler asthma therapy is better at preventing attacks than the current recommended treatment
WebMD UK Health News
Medically Reviewed by Dr Sheena Meredith
woman using astma inhaler

4th March 2013 - Two new trials claim using two types of common asthma medication combined in one inhaler is more effective at reducing attacks than the current recommended treatments for adults whose asthma is not well controlled.

The findings say using one inhaler for both preventive and rescue treatment (known as 'Single inhaler Maintenance and Reliever Therapy' or SMART) is safe and well tolerated.

However the findings challenge national and international medical guidelines, particularly those in the US, where this approach has yet to be approved.

The findings have been welcomed by Asthma UK, which says a single inhaler approach has been available to over 18s for nearly 10 years.

Prevention and relief

Despite effective drug treatment options, most adults with asthma fail to achieve good control of their symptoms. It's currently recommended these patients are prescribed an inhaled corticosteroid to help prevent attacks, sometimes along with a long-acting beta2 agonist (LABA) in a combination inhaler if the steroid alone is insufficient to keep attacks under control. All patients should also have a second inhaler containing a short-acting beta2 agonist (SABA) to treat symptoms (reliever therapy).

In contrast, SMART uses just a single inhaler containing both a steroid and a LABA bronchodilator as both preventive and reliever treatment.


Previous studies have reported that higher doses of steroids do not improve symptoms for all patients and can have substantial side effects, while LABAs have come under scrutiny for their risk of worsening asthma symptoms.

However, the first study of 1714 adults (aged 18 or over)with moderate persistent asthma from 14 European countries found that those treated with SMART (the steroid beclometasone and the bronchodilator formoterol in combination) had a significantly reduced risk of severe asthma attacks and hospitalisation or urgent medical care compared to current best practice.

The second study, by a team of researchers from New Zealand, involved 303 adults (16-65 years) at increased risk of asthma flare-ups and who had high use of reliever medication. It reported that those treated with SMART (in this case the steroid budesonide and the bronchodilator formoterol) reduced the risk of severe asthma exacerbations without increasing the risk of bronchodilator over use or increasing long-term steroid exposure.

The studies, one funded by a pharmaceutical company, the other by the Health Research Council of New Zealand, are published in The Lancet Respiratory Medicine.


Reacting to the studies in an emailed statement, Angela Jones, specialist asthma nurse at Asthma UK says: "We welcome these two research papers. They throw further light on the effectiveness and safety of the combined single inhaler, known as SMART. They also examine other drug combinations that can be used in the same way. Enabling people to self-adjust their combination inhaler according to their symptoms, thereby reducing the number and risk of asthma attacks, is good news for people with asthma."

She says anyone with asthma wondering if the combined inhaler is suitable for them should talk to their GP, asthma nurse or call Asthma UK's advice line.

Reviewed on March 04, 2013

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