SMART Asthma Therapy
Asthma is a chronic inflammatory disease of the airways that causes frequent symptoms of coughing, chest tightness, wheezing and/or shortness of breath.
If the symptoms are less frequent than twice a week during the daytime and less than twice a month during the nights, it is termed “intermittent” asthma. If the symptoms are more frequent than twice a week during the daytime and more than twice a month during the nights, it is called “persistent” asthma. Persistent asthma is further subdivided into mild, moderate, and severe based on the severity and frequency of the asthma symptoms as well as lung function measurements obtained by pulmonary function tests.
Intermittent asthma is traditionally treated with an as needed “rescue” inhaler medication, which is usually an albuterol (e.g., ProAir, Proventil, Ventolin) inhaler. Albuterol is a short-acting beta 2 agonist bronchodilator medication which acts as a dilator of the bronchial tubes of the lungs. It provides quick relief for the wheezing, chest tightness, coughing, and shortness of breath that plagues asthma sufferers. The usual dose is 2 puffs from the inhaler every 4 to 6 hours as needed for symptom relief. Albuterol can also be used prior to exertion for the prevention of exercise-induced asthma symptoms.
Persistent asthma, on the other hand, needs a daily scheduled maintenance medication in order to control the inflammation that occurs in asthmatics. The daily maintenance medication helps prevent symptoms and preserve the lung function in the long term. The maintenance medication usually consists of a corticosteroid in the form of an inhaler [Flovent (fluticasone), QVAR Redihaler (beclomethasone), Asmanex (mometasone), Pulmicort (budesonide), Arnuity (fluticasone), Alvesco (ciclesonide), Aerobid (flunisolide)] which is usually taken either once or twice a day. There is also another maintenance therapy that does not include a corticosteroid. Such non-steroid maintenance medications typically are known as leukotriene antagonists [e.g., Singulair (montelukast), Accolate (zafirlukast), Zyflo (zileuton)]. It is up to the allergist and patient to decide which type of maintenance therapy is best for that patient.
Since a maintenance medication is needed in most persistent asthmatic patients, usually 2 different types of inhalers are needed in total – one for the daily preventive maintenance and the other for the as needed quick relief for asthma symptoms. Though it is an effective way of treating asthma, it can sometimes lead to confusion for some patients, so it is necessary for the board certified allergist to explain how and when to use both types of medications.
There has been a recent update in the recommendations for asthma management from the National Asthma Education and Prevention Program. The newer guidelines recommend one inhaler both for prevention and rescue therapy. This new recommendation is termed Single Maintenance And Reliever Therapy (SMART).
The recommended inhaler contains a combination of a corticosteroid (anti-inflammatory agent) and a short-acting beta 2 agonist bronchodilator to open the airways quickly. In addition to using it once or twice a day on a regular daily basis for maintenance, the patient can take one or two puffs from the same inhaler as needed for the rapid relief of the symptoms. SMART therapy is approved for children who are 5 years old and above.
Clinical studies have shown that SMART therapy reduces acute flare-ups, emergency healthcare visits, and hospitalizations compared to the traditional therapy in patients with moderate and severe persistent asthma. However, If the patient’s current therapy is controlling their asthma well and they are not having side effects, there is no need to make a change.
There are 2 main corticosteroid medications recommended for SMART therapy: budesonide and mometasone. These 2 corticosteroids can be used as the preventive component. Formoterol is a faster acting long-acting beta 2 agonist that is used as the rescue component. Only formoterol-containing formulations should be used. Formoterol has a more rapid onset bronchodilator effect than other long-acting beta 2 agonists, similar to albuterol. Budesonide/formoterol (i.e., Symbicort) is the most commonly used formulation for SMART therapy, but mometasone/formoterol (i.e., Dulera) may also be used.
The board certified allergy specialists at Black & Kletz Allergy have been treating asthma in pediatric and adult patients for more than 5 decades. We have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area which are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. If you or someone you know has asthma or any other allergic or immunologic condition, please make an appointment so that we may help you. Alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy have been treating patients in the Washington, DC metropolitan area for allergies, asthma, sinus disease, and immunologic disorders for more than 50 years. We would be pleased to provide allergy and asthma relief for you and your family in a relaxed, caring, and professional environment.
Of all the ailments that people seek an allergist’s care for, one of the most bothersome conditions is 
The esophagus is the muscular tube that propels food from the mouth into the stomach through a rhythmic, coordinated peristaltic action. The interior lumen of the tube is covered by a thin mucus membrane. This normal function can be impaired when the structure is chronically inflamed by various allergic triggers. A subset of white blood cells, called eosinophils, accumulate in the mucus membrane of the esophagus in response to the exposure of allergens that an individual is sensitized to. These eosinophils will release a number of chemical mediators of inflammation into the tissues causing structural and functional damage. When this occurs, the individual has a condition called eosinophilic esophagitis (EoE).
Pollen Food Allergy Syndrome (also called pollen food allergy syndrome) is a condition where there is a cross reaction to allergens that are found both in pollen and certain foods. The most common foods associated with pollen food allergy syndrome include fresh fruits, vegetables, and some tree nuts. The disorder affects roughly one-third of individuals with 
This year so far it has been much warmer than usual for Winter. Typically in the 
Nearly all children get infected with respiratory syncytial virus (RSV), a highly contagious virus, by their second birthday. RSV has a seasonal predilection, usually from December to March every year. In most instances, it causes mild “cold-like” symptoms and resolves without complications in approximately 1-2 weeks.
In the U.S., dogs are the most common pets. According to the American Veterinary Medical Association, approximately 77 million pet dogs are living in the country spread around roughly 49 million homes. This means that each dog-owning household has an average of 1.5 dogs. The most common breed of dog is the Labrador Retriever. The second most common pets are cats. According to the American Veterinary Medical Association, there are about 32 million homes in the U.S. with cats comprising of approximately 59 million cats in total. Thus, the average cat-owning home has an average of 1.8 cats. The most common breed of cat is the Ragdoll. Fish, birds (e.g., parakeets, cockatiels, parrots), reptiles (e.g., lizards, turtles, snakes, geckos), rabbits, poultry (e.g., chickens, ducks, turkeys, geese), hamsters, guinea pigs, and ferrets round off the top 10 most common pets in the U.S. in that order. Overall, about 70% of homes have at least one pet. The number of pet-owning households continues to rise compared with ownership in the past.