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by Marijana Domazet, Tuesday, 19 March 2013 | Categories: Asthma

In the UK, most individuals with asthma are well aware of the possibility to use an inhaler that contains a combination of corticosteroids and so-called LABA. In fact, in the UK the treatment (which is commonly called SMART) appears to have been widely available for adults for nearly ten years. Yet, two trials that were recently published in The Lancet Respiratory Medicine recently appear to have met some resistance in the US, with some sources claiming that recommending the use of SMART inhalers would go against national and international medical guidelines, that clinicians’ perceptions of the efficacy of SMART are not the same as patients perceptions and that the promotion of SMART inhalers reflects financial interests rather than a concern for patients well-being. In this blog post, we consider whether there is any foundation behind those statements and whether the findings from the two studies warrant a serious consideration of SMART treatments.

The first study, conducted by Patel et al, was a 24 week trial that included a total of 301 patients. The participants, who were between the ages of 16 and 65 were randomly put into groups that either used SMART inhalers or used standard inhalers. The key findings indicate that individuals in the SMART group had fewer severe asthma exacerbations, leading the researchers to conclude that SMART is a particularly suitable treatment for adults that are at risk of having severe asthma exacerbations.

In addition to standardising the treatments so that they were comparable between the groups, the researchers also used an electronic device to ensure that the measurement of actuations was more precise than it had been in past studies. This study also differed from past studies, as the researchers did not use dry powdered inhaler and as it was the first study that had not received funding from a pharmaceutical company.

The second study, conducted by Papi et al, was a double blind trial that was conducted between a total of 14 European countries (183 centres) over the course of 48 weeks. The 1714 participants, who were over the age of 18, were randomly put into groups that either used a combination of corticosteroids and LABA or only relied on LABA. After controlling for factors such as lung function, symptoms scores and asthma exacerbation, the findings suggested that the latter group had severe exacerbations earlier than the former group. Moreover, individuals in the former group also had fewer mild asthma exacerbations. Based on this the researchers concluded that the using a combination of corticosteroids and LABA would be useful for patients with moderate to severe asthma.

Given that this trial controlled for many aspects that previous studies did not address sufficiently, it is unlikely that the findings from this large-scale trial are random. The sheer size of the trial, in combination with the blind design, makes it challenging to question the findings.

It is clear that both of the aforementioned trials are robust and unique in many ways. However, despite the fact that these studies corroborate findings of past trials and testimonies of clinicians, it also appears that patients’ perception of their symptoms improving or being better controlled as a result of using SMART inhalers is not always a given. This of course, should not be taken lightly. However, some likely explanations for this incongruence could be attributed to variations in diagnosis severity, triggers and medication compliance.

To our knowledge there are no studies to address this, but it does seem like a feasible explanation for the incongruence between clinicians and some patients’ perceptions. We believe that rather than considering negative patient testimonies as noise, it would be valuable to understand the difference between patients who find SMART useful and patients who do not. This of course, is less extreme than suggesting that SMART treatments are breaching medical guidelines.

In conclusion, we find it abundantly clear that the two studies are extremely valuable in further supporting the use of SMART inhalers. We see little support for the argument of financial motivation, especially when considering the Patel et al trial and hope that future research efforts are put into optimising the use of SMART inhalers for relevant patient groups.





 
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