<p>Asthma is a chronic inflammatory airway disease that requires effective long-term control to prevent exacerbations and reduce morbidity. Traditional treatment relies on separate inhalers for maintenance and symptom relief, often leading to suboptimal adherence, especially in pediatric patients. Single Maintenance and Reliever Therapy (SMART), which uses a single inhaler combining inhaled corticosteroid (ICS) and formoterol, offers a simplified and responsive treatment approach. This review evaluates the mechanisms, clinical efficacy, safety, and implementation of SMART therapy in asthma management for pediatric patients. As asthma care shifts toward personalized, symptom-driven management, SMART offers a promising solution for improving adherence, asthma management and outcomes in pediatric populations. With continued efforts toward larger implementation and approval, SMART has the potential to become a cornerstone in the modern management of pediatric asthma.</p><p>Evidence from randomized controlled trials and real-world studies supports SMART’s superiority compared to the traditional asthma management methods in reducing exacerbations, lowering cumulative steroid exposure, and improving overall asthma control, even among children and adolescents. SMART therapy is endorsed by the Global Initiative for Asthma (GINA) and the National Asthma Education and Prevention Program (NAEPP) for moderate to severe asthma, although regulatory and access challenges remain in the United States. This review also discusses practical considerations for clinicians, including patient education, safety monitoring, and system-level barriers such as cost and formulary restrictions.</p>