Published on in Health Tip of the Week
Families that have a child with asthma know the routine: every morning, the child needs to use one inhaler to take their daily maintenance medication to manage the disease. And they have to keep their rescue inhaler handy in case symptoms pop up during the day.
Now, for some kids who have frequent flares, there’s a SMARTer way to manage their asthma.
SMART stands for Single Inhaler for Maintenance And Relief Therapy. With SMART, two medicines are combined in one inhaler, so the child’s care is less complicated but still safe. Both the maintenance medication (daily inhaled corticosteroid) and the rescue medication (long- and RAPID-acting beta-agonists) are inhaled with one or two puffs once or twice a day, and as needed if the child has an asthma flare.
Following the science
The SMART strategy was endorsed by the 2020 updates to the National Asthma Education and Prevention Program (NAEPP) guidelines after extensive study and evaluation showed it can reduce the use of oral steroids, ED visits and hospitalizations by 60%.
The SMART inhalers come with varying doses of the medications, so it’s important to check with your child’s medical team to get the proper prescription for your child’s level of asthma.
Note: While SMART is approved for children 5 years old and above, the inhaler label may not say that. There is a lag time between its approval and when the drug makers catch up with labeling. This “off-label” use for younger children must be approved by your doctor.
How to use SMART inhalers
Your child’s doctor will review specific instructions for you, but generally children take one or two puffs of the SMART inhaler — preferably with a spacer — once or twice a day and, if symptoms begin to arise, another one to two puffs. Wait four to six hours, as directed by your doctor, before taking another puff.
The maximum doses a day are eight puffs for those 5 to 11 years old and 12 puff for children 12 and older.
Athletes with asthma may need a puff of their SMART inhaler before workouts; check with your doctor to make sure.
Do not use the combination inhaler ADVAIR® as your SMART inhaler. Although it contains an inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA), the LABA in ADVAIR has a slower onset of action compared to the LABA in Dulera® and Symbicort®, and will NOT provide quick relief. The SMART inhaler is used in place of Albuterol for quick relief of symptoms.
Is a SMART inhaler right for my child?
If your child has had severe flares leading to oral steroids, emergency room visits or admissions to the hospital, speak to your asthma provider to see if SMART is right for them.
SMART may also be a good choice if your child struggles to remember to take their daily maintenance medication and ends up needing their SABA medicine, such as Albuterol or Xopenex, frequently.
SMART works best if your child has a good sense of when a flare is coming on and is willing to treat it before it gets bad.
You will also want to check with your health insurance and prescription plan to make sure SMART inhalers will be covered.
If your child’s current asthma plan is working great, it’s OK to stick with what works. The goal is to control the asthma so your child can have an active, normal childhood.
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Contributed by: Jeffrey M. Ewig, MD