Single-inhaler combination therapy for maintenance and relief of asthma: A new strategy in disease management

When an adequate standard of asthma control is not achieved with maintenance treatment of inhaled corticosteroids, the addition of a long-acting β2-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.