With adjustment for ethnicity , the SMART group had fewer days of high use ( relative rate ( RR ) 0.57 ( 95 % confidence interval ( CI ) : 0.38-0 .85 ) ) , days of high use without medical review within 48 h ( RR 0.49 ( 95 % CI : 0.32-0 .75 ) ) and severe exacerbations ( RR 0.54 ( 95 % CI : 0.36-0 .81 ) ) compared with standard .