Maintenance and Reliever Therapy (MART)

A MART treatment plan uses one inhaler as both a preventer and a reliever.

Find out about Maintenance and Reliever Therapy (MART), how it can help some people whose asthma is not well controlled, and how to deal with symptoms and asthma attacks if you use a MART inhaler.

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What is Maintenance and Reliever Therapy (MART)?

Maintenance and Reliever Therapy, or MART, is a type of asthma treatment plan. If you’re on a MART plan you have just one inhaler to use as a preventer and a reliever.

A MART inhaler is a specific type of combination inhaler that contains:

  • a steroid preventer medicine
  • a bronchodilator reliever medicine which opens the airways - in a MART inhaler, there’s a special type of bronchodilator that keeps the airways open (long-acting) and can also work quickly as your emergency reliever inhaler (short-acting).

A combination inhaler can only be used for MART if it has this specific type of long-acting bronchodilator - usually formoterol  - that can work quickly as well.  

Not all inhalers with formoterol are licensed for MART though. If you’re not sure which kind of combination inhaler you’re taking, speak to your GP, asthma nurse, or pharmacist.

When is a MART inhaler prescribed?

MART is mainly prescribed to adults (aged 18 or over). But some children over 12 may be prescribed a MART inhaler when their asthma is not well controlled.

Your GP or asthma nurse may consider MART to treat your asthma:

  • if you’re still getting asthma symptoms even though you’ve been taking your preventer medicine regularly as prescribed, and/or any add-on treatments
  • because it’ll be safer and easier for you to manage your asthma using just one inhaler that works as both a preventer and reliever.

When do you use your MART inhaler? 

Use your MART inhaler every day 

You need to take your MART inhaler every day as prescribed, usually one to two puffs every morning and evening. Take this ‘maintenance’ dose even when you’re feeling well to prevent symptoms.

Use your MART inhaler when you get symptoms 

You can also use your MART inhaler as a reliever when you get symptoms. Always carry your MART inhaler with you so you can quickly take a ‘reliever’ dose if you need it.

 

Only inhalers licensed for MART can be used as your reliever inhaler too

Other types of combination inhalers cannot give quick relief, because they don’t have the fast-acting medicine in them. If you’re not on a MART plan, you still need your usual blue reliever inhaler to deal with symptoms or an asthma attack.

How can MART help your asthma?

Your MART inhaler can help your asthma by:

  • keeping down inflammation in your airways
  • giving ongoing relief from symptoms such as breathlessness and a tight chest
  • acting quickly to deal with symptoms or an asthma attack
  • reducing your risk of an asthma attack that needs high doses of oral steroids.

Your everyday maintenance dose gives you both a dose of steroid preventer medicine and a dose of long-acting bronchodilator medicine.

This means you’re reducing inflammation in your airways and keeping your airways open. You should find you can breathe more easily.

Your ‘reliever’ dose gives you a dose of fast-acting reliever medicine to quickly deal with symptoms. At the same time, it gives you a top-up boost of your steroid preventer medicine, which helps deal with the inflammation in your airways.

Using MART when your symptoms get worse

You take your MART inhaler every day as prescribed, usually twice a day. But if your symptoms get worse at any point during the day, you can use it as a reliever inhaler too.

This is because it contains a fast-acting medicine called formoterol, which deals with symptoms quickly.

And as well as benefiting from the reliever medicine, each time you take your MART inhaler for relief of symptoms, you also get a dose of steroid preventer medicine. This calms the inflammation in your airways.

If you’re using your MART inhaler for rescue reliever medicine

once a day or more - on a regular basis - see your GP or asthma nurse to review your treatment.

Make sure you have a MART action plan 

Your personalised MART action plan needs to tell you how many puffs to take morning and evening every day, and how many to take if you have symptoms.

There is usually a maximum dose of day, including your maintenance doses. Always talk to your GP or asthma nurse if you’re not sure how to use your MART inhaler, or if you’re regularly using extra doses.

MART asthma attack advice

Asthma attack advice is different if you’re on a MART treatment plan.

Ask your GP or asthma nurse to write down in your action plan exactly how to use your specific brand of MART inhaler if you have an attack.

You need to know:

  • How many puffs of your MART inhaler you need to take if symptoms flare up
  • How long you should wait between puffs
  • When to call 999 if there is no improvement
  • How many puffs you can continue to take while waiting for the ambulance.

Switching to a blue reliever for an asthma attack 

Some people find it hard to get the dry-powder medicines in their MART inhaler deep enough into their lungs during an asthma attack.

If you’ve noticed this, ask your GP or asthma nurse about having a blue reliever inhaler and a spacer to use just for emergency asthma attacks.  

If you do use a blue reliever inhaler for asthma attacks, then follow the usual asthma attack advice. But make sure it is all written down clearly in your MART action plan.

Are there any side effects?

It's likely that any side effects will be the same as for a separate preventer and reliever inhaler, or a combination inhaler.

Common side effects (affecting less than 1 in 10 people) include:

  • thrush in your mouth or throat or a hoarse voice from the steroid preventer medicine You can avoid this by always rinsing out your mouth after taking it.

Less common side effects (affecting less than 1 in 100 people) include:

  • quicker heartbeat, palpitations, trembling or feeling sick from the bronchodilator in your inhaler (formoterol).

Your GP or asthma nurse will always aim for the lowest maintenance dose needed to control symptoms and lower your risk of side effects.

As long as you’re managing your asthma well with regular maintenance doses, the dose will remain low. See your GP or asthma nurse if you notice you’re using your MART inhaler as a reliever more often than usual.

Whenever you start a new medicine you should see your GP or asthma nurse six to eight weeks later to talk about how it’s working for you.

You can also check on your medicines and symptoms at your asthma review and other regular appointments.

If you have any questions or concerns about MART treatment plans you can call the Asthma UK Helpline on 0300 222 5800 (Mon-Fri 9am-5pm) to speak to a respiratory nurse specialist. Or you can message them via WhatsApp on 07378 606 728.

 

Last updated May 2021

Next review due May 2024

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