When an adequate standard of
asthma control is not achieved with maintenance treatment of inhaled
corticosteroids, the addition of a long-acting beta(2)-adrenergic receptor agonist (LABA)
bronchodilator is recommended. Using a combination product,
salmeterol/
fluticasone propionate (
Seretide or
Advair) or
budesonide/
formoterol (
Symbicort) is preferred for convenience and avoids any risk that LABA might be used as monotherapy. As
formoterol has a rapid onset of
bronchodilator effect, the
budesonide/
formoterol combination can be used for both the maintenance and reliever components of
asthma treatment (
Symbicort SMART) and this is endorsed as an effective treatment by the Global Initiative for
Asthma. The efficacy of this approach has been evaluated in a series of well conducted, controlled studies. Current control of
asthma symptoms is improved or achieved with reduced total dose administration with
Symbicort SMART compared with any reasonable alternate option. In every study, the risk of severe exacerbations was lower with
Symbicort SMART than comparator treatment. Patients who benefit to the greatest extent are those with evidence of more severe
asthma and greater exacerbation risk. When initiated in suitable patients in conjunction with appropriate education,
Symbicort SMART is dominant in pharmacoeconomic terms.
Symbicort SMART delivers improved
asthma outcomes with lower treatment and social costs than any alternative.