Newer Treatment Options for Managing Moderate to Severe Asthma in Adults

People with moderate to severe asthma are typically prescribed a controller medicine, such as an inhaled corticosteroid (ICS), used daily to prevent asthma symptoms and a quick reliever, such as albuterol, used when they have symptoms. What if, every time you had symptoms, you used both your quick-reliever and your controller medicine?

There are two approaches that have been recently published in the literature, but healthcare providers may not be implementing these treatment options just yet:

Single Maintenance And Reliever Therapy (SMART)
Patient Activated Reliever-Triggered Inhaled Corticosteroid (PARTICS)

What is SMART?

SMART means using one inhaler every day to prevent asthma symptoms and using the same inhaler to treat asthma symptoms once they start. The medication used for SMART is a combination medicine that includes an inhaled corticosteroid (ICS) and a long-acting beta-2 agonist (LABA) called formoterol. The ICS reduces the overall inflammation, while the LABA relaxes the smooth muscles in the airways. Currently, this combination medicine is available as budesonide/formoterol fumarate dihydrate (for 12 years or older) or mometasone furoate/formoterol fumarate dihydrate (for 5 years or older).

With SMART therapy, patients are instructed to use the combination medicine twice daily and when symptoms occur. Studies on this approach showed that participants experienced fewer asthma episodes and improved asthma control.

What is PARTICS?

In the PARTICS approach patients, patients continue on their current treatment plan and are instructed to take one puff of Inhaled Corticosteroid (ICS) for each puff of quick reliever or five puffs of ICS after their nebulizer machine treatment.

The PARTICS approach was included in a recent study called PREPARE (Person EmPowered Asthma Relief) and was conducted with Black and Hispanic/Latinx populations. The study was recently published in the New England Journal of Medicine called, “Reliever-Triggered Inhaled Glucocorticoid in Black and Latinx Adults with Asthma.” Study participants experienced fewer asthma attacks, fewer days lost from work or school, better asthma control and better quality of life.

SMART vs. PARTICS

Both SMART and PARTICS approaches were conducted among people with moderate-to-severe asthma. The PARTICS study specifically looked at outcomes among Black and Hispanic/Latinx populations, who typically are underrepresented in studies.

With SMART, patients use a combination ICS with formoterol (a long-acting reliever) twice a day and when symptoms arise. In PARTICS, patients stayed on their usual care and added an ICS when they used their reliever (albuterol) medicine. The SMART studies did not take into account that many patients do not stick to their treatment plan and may forget to use their daily controller twice a day.

Other comparisons between SMART and PARTICS include that a large proportion of patients with moderate to severe asthma use nebulizers (the SMART studies excluded patients who used these machines). Also, SMART excluded people who smoked or had other diseases and only included people who met specific breathing test criteria. SMART did not include many Black or Latinx patients. Further, implementation of SMART requires changing the treatment medicine and is not consistently covered by health insurance.

Is SMART or PARTICS right for me?

If you have moderate to severe asthma and your asthma is not well controlled with your current treatment plan, talk to your doctor about these options to see if SMART or PARTICS may be right for you.

Is your asthma under control? Take the My Asthma Control Assessment. This is an easy to complete 7 questions survey with a printable summary to bring to your doctor and start the discussion. The webpage “Questions to Ask your Doctor about Asthma” may also be helpful.

If you are looking for assistance or have additional questions take our free Asthma Basics, join the Better Breathers Network or contact the Lung Helpline at Lung.org/asthma. To learn more about the PREPARE study, visit their website at: preprestudy.net.