Clinicians' experiences with SMART: Single Maintenance and Reliever Therapy

ATS Breathe Easy

In this podcast, Dr. Ally Larkin, Dr. Carol Mansfield, and Dr. Robyn Cohen discuss their experience implementing Single Maintenance and Reliever Therapy (known as "SMART" or "MART"). SMART is included in the 2020 updates to the National Asthma Education and Prevention Program Asthma Management Guidelines and the 2021 updates to the Global Initiative for Asthma Strategy. In this discussion, they cover how they implemented SMART into their clinical practice, challenges they've faced making the change, how SMART has improved asthma management and control for their patients, and advice for providers seeking to implement SMART into their own practices.

References:

New NAEPP/NHLBI Guidelines (2020):

Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC); Cloutier MM, Baptist AP, Blake KV, Brooks EG, Bryant-Stephens T, DiMango E, Dixon AE, Elward KS, Hartert T, Krishnan JA, Lemanske RF Jr, Ouellette DR, Pace WD, Schatz M, Skolnik NS, Stout JW, Teach SJ, Umscheid CA, Walsh CG. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-1270. doi: 10.1016/j.jaci.2020.10.003. Erratum in: J Allergy Clin Immunol. 2021 Apr;147(4):1528-1530. PMID: 33280709; PMCID: PMC7924476.

New GINA Guidelines (2021):

Reddel HK, Bacharier LB, Bateman ED, Brightling CE, Brusselle GG, Buhl R, Cruz AA, Duijts L, Drazen JM, FitzGerald JM, Fleming LJ, Inoue H, Ko FW, Krishnan JA, Levy ML, Lin J, Mortimer K, Pitrez PM, Sheikh A, Yorgancioglu AA, Boulet LP. Global Initiative for Asthma Strategy 2021: Executive Summary and Rationale for Key Changes. Am J Respir Crit Care Med. 2022 Jan 1;205(1):17-35. doi: 10.1164/rccm.202109-2205PP. PMID: 34658302; PMCID: PMC8865583.

Articles on Implementation:

Reddel HK, Bateman ED, Schatz M, Krishnan JA, Cloutier MM. A Practical Guide to Implementing SMART in Asthma Management. J Allergy Clin Immunol Pract. 2022 Jan;10(1S):S31-S38. doi: 10.1016/j.jaip.2021.10.011. Epub 2021 Oct 16. PMID: 34666208.

Cloutier MM, Teach SJ, Lemanske RF Jr, Blake KV. The 2020 Focused Updates to the NIH Asthma Management Guidelines: Key Points for Pediatricians. Pediatrics. 2021 Jun;147(6):e2021050286. doi: 10.1542/peds.2021-050286. Epub 2021 May 3. PMID: 33941586; PMCID: PMC8168603.

Article on the Implementation Gap:

Krings JG, Sekhar TC, Chen V, Blake KV, Sumino K, James AS, Clover AK, Lenze EJ, Brownson RC, Castro M. Beginning to Address an Implementation Gap in Asthma: Clinicians' Views of Prescribing Reliever Budesonide-Formoterol Inhalers and SMART in the United States. J Allergy Clin Immunol Pract. 2023 Sep;11(9):2767-2777. doi: 10.1016/j.jaip.2023.05.023. Epub 2023 May 26. PMID: 37245736.