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SMART dosing an 'effective alternative' for uncontrolled asthma

By Nigel Praities

A combined inhaler is ‘an effective option' for both maintenance and rescue therapy in adults with poorly controlled asthma, say new recommendations from the National Prescribing Centre.

The endorsement follows the inclusion of the budesonide/formoterol combined inhaler as an option for reliever therapy in uncontrolled step 3 asthma – known as SMART dosing – in the recently published BTS/SIGN guidelines.

The NPC guidance says although its place in routine practice is ‘not well established', GPs should consider SMART dosing as an alternative to increasing the inhaled steroid dose or adding another medication in those who are having exacerbations.

Dr Neal Maskrey, director of evidence-based therapeutics at the National Prescribing Centre, said the rate of severe asthma exacerbations could be reduced by up to 47% with this method of dosing, compared with fixed dose ICS/LABA dosing.

‘This has been shown to be an effective option but has only been investigated in the minority of people whose asthma is poorly controlled at Step 3 or 4 of the BTS/SIGN guideline,' he said.

Professor David Price, a GP in Norwich and professor of primary care respiratory medicine at the University of Aberdeen, said although NICE recommends using the least costly combination inhaler, SMART dosing was still a ‘very good option' for about a third of patients.

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