AIR and SMART Therapy for Asthma

Asthma treatment should let you do your normal activities, exercise and sleep without problems. You should not need to go to urgent care or the hospital. Most patients should only need their quick-relief inhaler two times a week or less, or two nights a month or less.

An allergy and immunology specialist doctor can make a personal treatment plan just for you. You should see this doctor for your asthma and any allergy problems.

What are AIR and SMART?
AIR and SMART are plans for using medicine to treat asthma. Both plans use two medicines together:
•    A bronchodilator that opens up your airways (like albuterol or formoterol)
•    An inhaled steroid that reduces swelling in your airways (like budesonide or mometasone)

Using both medicines together works better than using just one. They can come in the same inhaler or in two separate inhalers used at the same time.

What do AIR and SMART stand for?
AIR = Anti-Inflammatory Reliever therapy
SMART = Single Maintenance and Reliever Therapy

What is the difference between AIR and SMART?
AIR is for people who only need medicine when asthma symptoms happen, not every day.

SMART is for people who need daily asthma medicine plus extra medicine when symptoms happen.

Who can use AIR or SMART?
AIR is for asthma patients age 5 and older who have mild asthma and don't need daily medicine.

SMART is for asthma patients age 5 and older who have moderate to severe asthma.

What are the benefits of AIR and SMART?
AIR and SMART help prevent serious asthma attacks better than using separate inhalers. They can also lower the amount of steroids you need, which reduces the chance of steroid side effects.

What are the challenges with AIR and SMART?
The Global Initiative for Asthma (GINA) and the National Asthma Education and Prevention Program (NAEPP) recommend these approaches for patients with moderate to severe asthma.

The U.S. Food and Drug Administration (FDA) has not approved using certain inhalers (budesonide-formoterol or mometasone-formoterol) as rescue inhalers for AIR or SMART in the United States. Other countries like the UK, Australia, and New Zealand have approved SMART therapy. Because the FDA hasn't approved it here, your health insurance may not cover these inhalers.

Also, insurance may limit how many inhalers they pay for each month. If you use SMART, you might need more than one inhaler per month.

How can you work with your doctor on AIR and SMART?
•    Learn about AIR and SMART
•    Work with your doctor to make a personal plan for using your inhaler(s)
•    Ask your doctor any questions or share any worries you have
•    Keep up with regular check-up appointments
•    Stick to your treatment plan

Anti-Inflammatory Reliever Therapy (AIR)

What medicines are used in AIR?
•    Budesonide-Albuterol (AirSupra)
•    Budesonide-Formoterol (Symbicort)
•    Mometasone-Formoterol (Dulera)

Budesonide and mometasone are inhaled steroids. Albuterol and formoterol are bronchodilators. Albuterol works for 4-6 hours. Formoterol works for 12 hours. If your insurance doesn't cover a combined inhaler, your doctor may prescribe two separate inhalers instead.

How do you use AIR medicines?

Single Maintenance and Reliever Therapy (SMART)

What medicines are used in SMART?

How many puffs are in one inhaler, and when should you get a new one?
A standard canister of Symbicort or Dulera has 120 puffs. Since SMART uses the inhaler both daily and as needed, you may run out faster than expected. Replace your inhaler when you have 20 puffs left.

How you can benefit from Shared Decision-Making (SDM) with SMART and AIR therapies:
1. Learn About SMARTand AIR: Understand that your inhaler controls asthma and provides quick relief by combining two medicines.
2. Get a Personalized Plan: Work with your doctor to create a clear plan on how and when to use your SMART inhaler for both maintenance and relief.
3. Address Concerns: Discuss any worries or questions about using a single inhaler for both control and relief with your doctor.
4. Use Helpful Tools: Decision aids and apps can help you understand and choose the best treatment for you.
5. Keep Up with Check-Ups: Regular follow-ups help ensure your treatment is working and make any needed adjustments.
6. Stay Motivated: Motivational techniques can help you overcome doubts and stay committed to your treatment plan.

Following these steps can help you manage your asthma more effectively with SMART and AIR therapies.

An allergy and immunology specialist physician is a trained expert in asthma and can develop an individualized therapy plan for your asthma. See your allergy and immunology physician for evaluation of your asthma and your other allergic conditions.

Find out more about asthma.

References
1. Cloutier MM, Baptist AP, Blake KV, Brooks EG, Bryant-Stephens T, DiMango E, et al. 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020;146(6):1217-1270.
2. Global Initiative for Asthma. Global strategy for asthma management and prevention, 2024 update. Fontana, WI: Global Initiative for Asthma; 2024. Available from: https://ginasthma.org/2024-report/
3. Reddel HK, Bateman ED, Schatz M, Krishnan JA, Cloutier MM. A practical guide to implementing SMART in asthma management. J Allergy Clin Immunol Pract. 2022;10(1).
4.  Arora NS, Zhou S, Baptist AP. Regulatory and insurance challenges must be overcome in the United States to meet global standards for asthma management. J Allergy Clin Immunol Pract. 2024;12(3):624-626.

The AAAAI's Find an Allergist / Immunologist service is a trusted resource to help you find a specialist close to home.

6/12/2026