Is the SMART approach better than other treatment approaches for prevention of asthma exacerbations? A meta-analysis
Background and Aims. The combination of inhaled corticosteroids (ICS) and long-acting β2 agonists (LABA) has been used as a single inhaler both for maintenance and reliever therapy in asthma, the SMART approach. The administration of additional CS with each reliever inhalation in response to symptom...
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2016-01-01
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| Series: | Monaldi Archives for Chest Disease |
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| Online Access: | https://www.monaldi-archives.org/index.php/macd/article/view/348 |
| _version_ | 1818536185619808256 |
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| author | R. Agarwal A. Khan A.N. Aggarwal D. Gupta |
| author_facet | R. Agarwal A. Khan A.N. Aggarwal D. Gupta |
| author_sort | R. Agarwal |
| collection | DOAJ |
| description | Background and Aims. The combination of inhaled corticosteroids (ICS) and long-acting β2 agonists (LABA) has been used as a single inhaler both for maintenance and reliever therapy in asthma, the SMART approach. The administration of additional CS with each reliever inhalation in response to symptoms is expected to provide better control of airway inflammation. The aim of this meta-analysis was to evaluate the efficacy and safety of the SMART approach versus other approaches in the management of asthma in preventing asthma exacerbations. Methods. We searched the MEDLINE and EMBASE databases for studies that have reported exacerbations in the SMART group versus the control group. We calculated the odds ratio (OR) and 95% confidence intervals (CI) to assess the exacerbations in the two groups and pooled the results using a random-effects model. Results. Our search yielded eight studies. The use of SMART approach compared to fixed-dose ICS-LABA combination significantly decreased the odds of a severe exacerbation (OR 0.65; 95% CI, 0.53-0.80) and severe exacerbation requiring hospitalization/ER treatment (OR 0.69; 95% CI, 058- 0.83). The use of SMART approach compared to fixed-dose ICS also significantly decreased the odds of a severe exacerbation (OR 0.52; 95% CI, 0.45-0.61) and severe exacerbation requiring medical intervention (OR 0.52; 95% CI, 0.42-0.65). The occurrence of adverse events was similar in the two groups. There was some evidence of statistical heterogeneity. Conclusions. The SMART approach using formoterol- budesonide is superior in preventing exacerbations when compared to traditional therapy with fixed dose ICS or ICS-LABA combination without any increase in adverse events. |
| first_indexed | 2024-12-11T18:34:41Z |
| format | Article |
| id | doaj.art-95a89ba83f434aecb71668cde0dddd2b |
| institution | Directory Open Access Journal |
| issn | 1122-0643 2532-5264 |
| language | English |
| last_indexed | 2024-12-11T18:34:41Z |
| publishDate | 2016-01-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Monaldi Archives for Chest Disease |
| spelling | doaj.art-95a89ba83f434aecb71668cde0dddd2b2022-12-22T00:54:49ZengPAGEPress PublicationsMonaldi Archives for Chest Disease1122-06432532-52642016-01-0171410.4081/monaldi.2009.348Is the SMART approach better than other treatment approaches for prevention of asthma exacerbations? A meta-analysisR. Agarwal0A. Khan1A.N. Aggarwal2D. Gupta3Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, ChandigarhDepartment of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, ChandigarhDepartment of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, ChandigarhDepartment of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, ChandigarhBackground and Aims. The combination of inhaled corticosteroids (ICS) and long-acting β2 agonists (LABA) has been used as a single inhaler both for maintenance and reliever therapy in asthma, the SMART approach. The administration of additional CS with each reliever inhalation in response to symptoms is expected to provide better control of airway inflammation. The aim of this meta-analysis was to evaluate the efficacy and safety of the SMART approach versus other approaches in the management of asthma in preventing asthma exacerbations. Methods. We searched the MEDLINE and EMBASE databases for studies that have reported exacerbations in the SMART group versus the control group. We calculated the odds ratio (OR) and 95% confidence intervals (CI) to assess the exacerbations in the two groups and pooled the results using a random-effects model. Results. Our search yielded eight studies. The use of SMART approach compared to fixed-dose ICS-LABA combination significantly decreased the odds of a severe exacerbation (OR 0.65; 95% CI, 0.53-0.80) and severe exacerbation requiring hospitalization/ER treatment (OR 0.69; 95% CI, 058- 0.83). The use of SMART approach compared to fixed-dose ICS also significantly decreased the odds of a severe exacerbation (OR 0.52; 95% CI, 0.45-0.61) and severe exacerbation requiring medical intervention (OR 0.52; 95% CI, 0.42-0.65). The occurrence of adverse events was similar in the two groups. There was some evidence of statistical heterogeneity. Conclusions. The SMART approach using formoterol- budesonide is superior in preventing exacerbations when compared to traditional therapy with fixed dose ICS or ICS-LABA combination without any increase in adverse events.https://www.monaldi-archives.org/index.php/macd/article/view/348Bronchial asthmaSingle inhalerSMART approachInhaled corticosteroidsLong-acting beta agonists |
| spellingShingle | R. Agarwal A. Khan A.N. Aggarwal D. Gupta Is the SMART approach better than other treatment approaches for prevention of asthma exacerbations? A meta-analysis Monaldi Archives for Chest Disease Bronchial asthma Single inhaler SMART approach Inhaled corticosteroids Long-acting beta agonists |
| title | Is the SMART approach better than other treatment approaches for prevention of asthma exacerbations? A meta-analysis |
| title_full | Is the SMART approach better than other treatment approaches for prevention of asthma exacerbations? A meta-analysis |
| title_fullStr | Is the SMART approach better than other treatment approaches for prevention of asthma exacerbations? A meta-analysis |
| title_full_unstemmed | Is the SMART approach better than other treatment approaches for prevention of asthma exacerbations? A meta-analysis |
| title_short | Is the SMART approach better than other treatment approaches for prevention of asthma exacerbations? A meta-analysis |
| title_sort | is the smart approach better than other treatment approaches for prevention of asthma exacerbations a meta analysis |
| topic | Bronchial asthma Single inhaler SMART approach Inhaled corticosteroids Long-acting beta agonists |
| url | https://www.monaldi-archives.org/index.php/macd/article/view/348 |
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