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Is the SMART approach better than other treatment approaches for prevention of asthma exacerbations? A meta-analysis
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Is the SMART approach better than other treatment approaches for prevention of asthma exacerbations? A meta-analysis
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Journal Article
Is the SMART approach better than other treatment approaches for prevention of asthma exacerbations? A meta-analysis
2009
Overview
Background and Aims. The combition of inhaled corticosteroids (ICS) and long-acting β2 agonists (LABA) has been used as a single inhaler both for maintence and reliever therapy in asthma, the SMART approach. The administration of additiol CS with each reliever inhalation in response to symptoms is expected to provide better control of airway inflammation. The aim of this meta-alysis was to evaluate the efficacy and safety of the SMART approach versus other approaches in the magement 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 combition 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 traditiol therapy with fixed dose ICS or ICS-LABA combition without any increase in adverse events.
Publisher
PAGEPress Publications
Subject
