While it has not yet been approved in the United States, Symbicort may some day be available as a rescue inhaler as well as a preventative medicine. In this sense, it may be the dream inhaler we asthmatics have been yearning for.
According to asthmansw.org, SMART is an acronym for “Symbicort Maintenance And Reliever Therapy.” The SMART program is explained here:
"It is a daily asthma management approach that allows you to use a single Symbicort inhaler as both a preventer and a reliever. Currently Symbicort is the only medication available for use as BOTH a maintenance preventer and reliever.
SMART works this way as it contains two different types of medicine in the same inhaler - a preventer (Pulmicort [Budesonide]) as the long-acting reliever which helps to control redness and swelling in the airways, and a reliever (Oxis [Eformoterol]) which can not only work quickly, but can also last a long time.
A person using the SMART approach to manage their asthma would take a maintenance dose of Symbicort, usually morning and night to maintain or establish asthma control AND they would also take additional inhalations of Symbicort as needed to relieve symptoms.
SMART is suitable for all people aged 12 years or older who are currently recommended to take combination medication for their asthma.
Symbicort has been available in Europe since since 2000, and was first made available in the U.S. in 2007 as a combination inhaler to compete with Advair (which presently is No. 1 in the U.S. market).
Symbicort works as a rescue inhaler because Formoterol starts to open the air passages in your lungs in two to three minutes as compared to 10 to 20 minutes for Serevent (the long acting bronchodilator in Advair).
Still, while it’s approved as a rescue inhaler, the SMART programs limits the patient to eight puffs of Symbicort in any given day.
Likewise, it should always be used in concordance with an asthma doctor, and always as part of a physician directed asthma action plan like the ones linked to from this site.
By using Symbicort as a rescue inhaler, the asthmatic receives a boost of corticosteroid every time there is an asthma episode, instead of just using a rescue inhaler (like Albuterol). This basically allows the patient to increase his corticosteroid when he needs it, and decrease it when he’s doing well. In this way the asthmatic has more control
Thus, “Studies have shown that people using Symbicort SMART - an additional way of taking the existing Symbicort inhaler - took no extra inhaled steroids and needed fewer oral steroids compared to traditional treatment methods. They also experienced fewer asthma attacks.”
An Astra Zeneca sponsored study (the makers of Symbicort) noted the SMART program resulted in a 28 percent reduction in severe exacerbation compared to a regimine of using Symbicort twice a day while using something like Ventolin as a rescue inhaler in between.
According to this article at news-medical.net, researchers in the U.S. are reviewing data currently available and have “found no significant reduction in the number of asthma exacerbations that required hospitalization among the patients who used single inhaler therapy. However, the reviewers did find that fewer adults on single inhaler therapy had exacerbations needing a course of oral corticosteroids”
Researchers are also awaiting the results of five not yet to be released trials.
The pros of using Symbicort as a single inhaler are convenience, improved control, improved compliance, and that you will automatically be getting an additional boost of steroids right when you need it. This may especially benefit those who are compliant with their controller meds. (This asthma blogger does not like the SMART program).
A con of using Symbicort as a single inhaler is that for those who do not regularly use it, it usually takes two to three weeks for inhaled corticosteroids to start working, and therefore the added boost of corticosteroid may prove to be of no benefit.
So research is ongoing, and the debate, I am sure, will continue.
Whether the SMART program or something like it will ever be approved by the FDA is still open to debate. Yet if this is someday approved it will make available yet another alternative for physicians and asthmatics to try.
A Registered Respiratory Therapist and asthmatic