Association of Inhaled Corticosteroids and Long-Acting β-Agonists as Controller and Quick Relief Therapy With Exacerbations and Symptom Control in Persistent Asthma: A Systematic Review and Meta-analysis

Abstract

DM Sobieraj, ER Weeda, E Nguyen. JAMA. 2018;319(14):1485–1496 Because of the rapid onset of action of the long-acting β-agonist (LABA) formoterol, it has been hypothesized that the combined use of formoterol and inhaled corticosteroid (ICS) as needed, instead of short-acting β-agonists (SABAs), would provide quick symptom relief and also increased ICS doses during symptom deterioration and thereby be used to both manage asthma symptoms and reduce exacerbation risk. The use of ICS and formoterol as both controller and quick relief therapy has been termed single maintenance and reliever therapy (SMART). This strategy is recommended in international asthma guidelines, but currently, there are no ICS-LABA combination inhalers that are approved for SMART in the United States. The objective of the authors of this study was to identify and analyze data from published trials of patients with persistent asthma in which researchers compared the use of SMART versus conventional therapy with ICS with or without LABA as controller therapy and SABA as rescue therapy in patients aged ≥5 years. Patients ≥12 years old with persistent asthma from 16 randomized clinical trials ( N = 22 748 patients) were included. In this …