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Implementing and Evaluating the Effectiveness of Single Maintenance and Reliever Therapy (SMART) in Pediatric Primary Care 

Statement of Problem

Asthma is a leading cause of childhood morbidity and disparities nationwide. Yet, many providers have not adopted leading evidence-based recommendations for chronic asthma management, and many patients do not stick with their treatment plan.  

In 2020, the National Heart, Lung, and Blood Institute (NHLBI) introduced single maintenance and reliever therapy (SMART) as the preferred management strategy for children older than 5 with moderate to severe asthma. The SMART strategy simplified the traditional “two inhaler” approach, where one inhaler was used daily for management and the other as needed, into a single inhaler delivering both management and relief medications simultaneously.  

While SMART’s efficacy, safety, and real-world effectiveness have been demonstrated internationally, the approach has not yet been widely implemented or evaluated in practice among children in the U.S. 

Description

Next Steps

We anticipate that the findings of this study will inform national implementation and dissemination strategies for SMART. This work aims to establish an evidence base for the effectiveness of SMART in a racially diverse U.S. pediatric population and share effective clinical decision support enhancements or implementation manuals through existing national networks. In particular, we will share findings and strategies with state Medicaid formularies to inform policy.  

Ultimately, we hope the findings will help facilitate widespread and equitable implementation of SMART in pediatric health systems nationwide.  

For more information about the project partners, visit their websites: Children’s Hospital of Philadelphia (CHOP) Data Science and Biostatistics Team (DBSU), and CHOP Clinical Reporting Unit Team (CRU).

This project page was last updated in July 2025. 

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Implementing and Evaluating the Effectiveness of Single Maintenance and Reliever Therapy (SMART) in Pediatric Primary Care [online]. Available at: http://www.policylab.chop.edu. [Accessed: plug in date accessed here]. 

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