From the University of Illinois Chicago College of Pharmacy, Department of Pharmacy Practice, Chicago, Illinois (AFI); University of Illinois College of Medicine at Chicago, Chicago, Illinois (CW); University of Illinois College of Medicine at Chicago, Chicago, Illinois (JL); University of Illinois College of Medicine at Chicago, Chicago, Illinois (KH); University of Illinois Chicago College of Pharmacy, Department of Pharmacy Practice, Chicago, Illinois (JBJ); University of Illinois Chicago College of Pharmacy, Department of Pharmacy Practice, Chicago, Illinois (ATE).
J Am Board Fam Med. 2024 Jul-Aug;37(4):745-752. doi: 10.3122/jabfm.2023.230456R1.
Single maintenance and reliever therapy (SMART) is an asthma treatment approach that utilizes combined inhaled corticosteroids and long-acting β-agonists for maintenance and quick relief therapy. Despite the evidence for its benefits in asthma treatment and its adoption into American and international asthma guidelines and recommendations, SMART remains a practice of some debate. This article reviews the available evidence for SMART and offers guidance for its integration into comprehensive asthma management. Overall, short-acting β-agonist-only asthma therapy regimens should be avoided, regardless of condition severity (SOR A Recommendation). Family medicine clinicians should start SMART for patients requiring either GINA Step 3 or 4 therapy, especially if they have signs of poor adherence (SOR B Recommendation). Finally, use budesonide-formoterol over other inhaled corticosteroid/long-acting β-agonist combinations when implementing SMART (SOR B Recommendation).
单一维持和缓解治疗（SMART）是一种哮喘治疗方法，它使用联合吸入皮质类固醇和长效β-激动剂进行维持和快速缓解治疗。尽管有证据表明 SMART 在哮喘治疗中的益处，并且已被纳入美国和国际哮喘指南和建议中，但它仍然存在一些争议。本文回顾了 SMART 的现有证据，并为其纳入综合哮喘管理提供了指导。总的来说，无论病情严重程度如何，都应避免使用仅含有短效 β-激动剂的哮喘治疗方案（强烈推荐）。家庭医学临床医生应开始为需要 GINA 第 3 或 4 步治疗的患者实施 SMART，特别是如果他们有治疗依从性差的迹象（强烈推荐）。最后，在实施 SMART 时，应使用布地奈德-福莫特罗而不是其他吸入皮质激素/长效β-激动剂联合制剂（强烈推荐）。
