In SMART therapy, which component is increased to step up treatment?

In SMART therapy, which stands for Symbicort Maintenance and Reliever Therapy, the primary focus is on the use of a combination inhaler that contains both a long-acting beta-agonist (LABA) and an inhaled corticosteroid (ICS). When increasing treatment intensity within this framework, the inhaled corticosteroid component plays a critical role in managing airway inflammation, which is essential for controlling asthma symptoms effectively.

By increasing the dose of the inhaled corticosteroid, you enhance the anti-inflammatory effects, leading to improved control over chronic symptoms and a reduction in the frequency of exacerbations. This approach aligns with the goal of SMART therapy, where the same inhaler is utilized both for daily maintenance (regular dosing) and for relief of acute symptoms (when needed).

In contrast, increasing the dose of a short-acting bronchodilator or focusing on the frequency of rescue inhaler use would mainly address immediate relief of symptoms rather than managing underlying inflammation and preventing future exacerbations. Oral corticosteroid therapy is typically reserved for more severe cases or exacerbations and is not a routine part of stepping up treatment in SMART therapy.