Asthma (SMART) — ABIM Board MCQ

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Easy"Respiratory Medicine"Asthma (SMART)ABIM Board

A 29-year-old patient with moderate persistent asthma is starting low-dose budesonide-formoterol as daily controller therapy. According to the US National Asthma Education and Prevention Program focused update, which medication should also be used as needed for relief of asthma symptoms?

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Correct answer: B — Budesonide-formoterol

The correct answer is budesonide-formoterol. For patients age 12 years or older with moderate persistent asthma, the NAEPP recommends low-dose ICS-formoterol at Step 3 as both daily maintenance and as-needed reliever therapy. This single maintenance and reliever therapy strategy (SMART) is possible because formoterol has a rapid onset of action. Albuterol is the reliever used with conventional maintenance regimens, but ICS-formoterol is preferred when SMART is selected. Ipratropium may be added to a short-acting beta agonist during a severe acute exacerbation but is not the routine outpatient reliever. Montelukast does not provide rapid bronchodilation. Prednisone is reserved for clinically significant exacerbations and should not be used for routine as-needed symptom relief.

Reference: National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. 2020 Focused Updates to the Asthma Management Guidelines, Recommendation 12 and Implementation Guidance, 2020. https://www.nhlbi.nih.gov/sites/default/files/publications/FINAL%20508%20version_AsthmaManagementGuidelinesReport%2012-1-20.pdf