Single-inhaler combination therapy for maintenance and relief of asthma: a new strategy in disease management

Drugs. 2009;69(2):137-50. doi: 10.2165/00003495-200969020-00001.


When an adequate standard of asthma control is not achieved with maintenance treatment of inhaled corticosteroids, the addition of a long-acting beta(2)-adrenergic receptor agonist (LABA) bronchodilator is recommended. Using a combination product, salmeterol/fluticasone propionate (Seretide or Advair) or budesonide/formoterol (Symbicort) is preferred for convenience and avoids any risk that LABA might be used as monotherapy. As formoterol has a rapid onset of bronchodilator effect, the budesonide/formoterol combination can be used for both the maintenance and reliever components of asthma treatment (Symbicort SMART) and this is endorsed as an effective treatment by the Global Initiative for Asthma. The efficacy of this approach has been evaluated in a series of well conducted, controlled studies. Current control of asthma symptoms is improved or achieved with reduced total dose administration with Symbicort SMART compared with any reasonable alternate option. In every study, the risk of severe exacerbations was lower with Symbicort SMART than comparator treatment. Patients who benefit to the greatest extent are those with evidence of more severe asthma and greater exacerbation risk. When initiated in suitable patients in conjunction with appropriate education, Symbicort SMART is dominant in pharmacoeconomic terms. Symbicort SMART delivers improved asthma outcomes with lower treatment and social costs than any alternative.

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use
  • Albuterol / administration & dosage
  • Albuterol / analogs & derivatives
  • Albuterol / therapeutic use
  • Androstadienes / administration & dosage
  • Androstadienes / therapeutic use
  • Anti-Asthmatic Agents / administration & dosage*
  • Anti-Asthmatic Agents / economics
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / drug therapy*
  • Asthma / economics
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / economics
  • Bronchodilator Agents / therapeutic use*
  • Budesonide / administration & dosage
  • Budesonide / therapeutic use
  • Budesonide, Formoterol Fumarate Drug Combination
  • Controlled Clinical Trials as Topic
  • Drug Combinations
  • Ethanolamines / administration & dosage
  • Ethanolamines / therapeutic use
  • Fluticasone-Salmeterol Drug Combination
  • Humans


  • Adrenal Cortex Hormones
  • Androstadienes
  • Anti-Asthmatic Agents
  • Bronchodilator Agents
  • Budesonide, Formoterol Fumarate Drug Combination
  • Drug Combinations
  • Ethanolamines
  • Fluticasone-Salmeterol Drug Combination
  • Budesonide
  • Albuterol