What is SMART Therapy for Asthma?

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Published: November 28, 2022

Revised: July 7th, 2026

At a Glance: What is SMART Therapy for Asthma?

  • Single Inhaler: SMART (Single Maintenance and Reliever Therapy) uses one inhaler for both daily maintenance of asthma and quick relief during an asthma attack or flare.
  • Combination Drug: SMART combines an inhaled corticosteroid (ICS) with a long-acting beta-2 agonist (LABA: formoterol). The ICS reduces underlying inflammation while LABA acts quickly to open airways.
  • Recommendation: SMART is recommended for children and adults with moderate to severe asthma (based on clinical guidance).
  • Effectiveness: Clinical trials show this streamlined approach significantly lowers the risk of severe asthma flares.
A person in a black shirt holding an inhaler in one hand, with the other hand placed on their chest. They are standing outdoors near a green structure, with blurred grass in the background.

SMART therapy stands for Single Maintenance and Reliever Therapy. It is sometimes also called MART therapy, for Maintenance and Reliever Therapy, but SMART and MART are the same.

SMART therapy is for patients with moderate to severe asthma who need a combination treatment. This combined treatment consists of an inhaled corticosteroid and an inhaled long-acting beta-2 agonist (LABA). Typical therapy involves using different inhalers for maintenance and reliever. With SMART therapy, it allows patients to use one inhaler for both. The maintenance dose can be adjusted based on the needs of the individual, but it is typically at least two doses a day (either two at once or one dose twice a day).

What medicines are in SMART therapy?

SMART therapy is a combination of an inhaled corticosteroid and an inhaled LABA. Currently, this combination is available in two medications:

  • budesonide/formoterol (Symbicort®)
  • mometasone/formoterol (Dulera®)

In asthma guidelines for SMART therapy, the budesonide/formoterol combination is the recommended first treatment for moderate to severe asthma.

How does SMART therapy work?

SMART therapy allows people with asthma to use just one medication to control asthma symptoms. They use this single medication for both maintenance and reliever therapy.

Typical relief inhalers contain only a bronchodilator. Maintenance medications often include an anti-inflammatory inhaled corticosteroid. But with SMART therapy, the inhaler has both an anti-inflammatory inhaled corticosteroid and a LABA. This is helpful as it means people are getting daily medicine to keep their airways open. And when they are experiencing symptoms, they are getting extra anti-inflammatories. This helps to reduce airway inflammation.

Who can receive SMART therapy?

Under asthma guidelines, SMART therapy is recommended for people with moderate to severe asthma, including children ages 5 and older. In general, SMART therapy is considered an easier treatment plan to follow. SMART therapy may also be considered as an as-needed treatment for mild asthma. Formoterol is a long-acting inhaled medication but it works quickly, similar to quick-relief albuterol. Researchers recently conducted a series of clinical trials called SYGMA (Symbicort Given as Needed in Mild Asthma). The clinical trials found the rate of severe asthma flares in adolescents (ages 12 to 18) and adults with mild asthma was significantly lower when using Symbicort as needed, instead of just a short-acting bronchodilator as needed. Important: SMART therapy for mild asthma is not FDA-approved. Talk with your doctor about whether this may be an option for you or your child. Since it’s not FDA-approved, your health insurance may not cover it.

What is moderate to severe persistent asthma?

People with moderate asthma have daily symptoms or wake up at night due to symptoms at least once a week.

People with severe asthma have symptoms throughout the day despite following their treatment plan. They also report waking up at night with symptoms, even after taking treatment. Learn more about understanding asthma severity.

How will I know if SMART therapy is right for me or my child?

To determine if SMART therapy is right for you or your child, consider Shared Decision-Making. In Shared Decision-Making, you partner with your doctor to decide the right treatment approach. The treatment approach is based on your asthma control, lifestyle and other healthcare needs and preferences. Then you work together to develop an Asthma Action Plan so you know what to do for treatment when symptoms occur. Some questions to ask your doctor include:

  • Do I have moderate to severe asthma? Does my child?
  • Is SMART therapy appropriate for me or my child?
  • How can I tell if SMART therapy is working well?

What are important points for clinicians to know about SMART therapy?

  1. Traditional asthma management uses different medicines for maintenance versus reliever. SMART therapy uses the same medication for the maintenance and reliever.
  2. SMART therapy may take away some of the confusion about which inhaler to use and when for many patients.
  3. SMART therapy is part of the current National Asthma Education and Prevention Program (NAEPP). It is detailed in the 2020 National Heart, Lung, and Blood Institute (NHLBI) guidelines. SMART therapy is also detailed in 2022 Global Initiative for Asthma (GINA) guidelines.
  4. Your doctor may consider SMART therapy as an as-needed treatment for mild asthma but it is not currently FDA-approved for mild asthma.

SMART Therapy Questions & Answers (Q&A)

Here are some questions about SMART therapy that are often asked.

SMART therapy stands for Single Maintenance and Reliever Therapy. It uses one inhaler that contains both an inhaled corticosteroid and a fast-acting bronchodilator for daily asthma control and quick symptom relief. This approach can simplify treatment. It can help reduce the risk of asthma attacks and flare-ups.

Instead of carrying one inhaler for daily use and another for quick-relief use, a patient can use the same prescribed inhaler for both purposes under SMART therapy.

The SMART technique refers to using a single prescribed inhaler as both a maintenance medication taken regularly and a quick-relief medication taken when symptoms occur. A person may take scheduled doses in the morning and evening, then use the same inhaler for additional symptom relief if asthma symptoms develop during the day.

Yes, Symbicort® is one of the inhalers commonly prescribed as part of SMART therapy. Symbicort contains both an inhaled corticosteroid and formoterol, a fast-acting long-acting bronchodilator. A doctor will prescribe it based on a patient’s age and asthma severity.

SMART uses one inhaler for both daily asthma control and quick symptom relief. How often you can use SMART therapy depends on your age and the specific inhaler prescribed. Most people take scheduled daily doses and can take additional doses when symptoms occur, up to a maximum number of inhalations per day.

It is important to follow your Asthma Action Plan and talk with your healthcare provider about the right dose for you.

You may consider starting SMART therapy when asthma is not adequately controlled with current treatment. Or your healthcare provider may determine that using a single inhaler for both maintenance and quick relief may improve your asthma management.

If you have frequent asthma symptoms despite using a daily controller inhaler, discuss switching to SMART therapy with your healthcare provider.

Reviewed by:
Bradley Chipps, MD, FACAAI, is a board-certified allergist and pediatric pulmonologist with Capital Allergy and Respiratory Disease Center in Sacramento, California. He earned his medical degree from University of Texas Medical Branch in Galveston in 1972. He is Past President of the American College of Allergy, Asthma and Immunology (ACAAI).

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