Maintenance and Reliever Therapy (MART)

Some people with asthma are prescribed Maintenance and Reliever Therapy (MART) for extra help with their asthma symptoms.

What is Maintenance and Reliever Therapy? 

When to take your MART inhaler

Do I need a blue reliever as well as my MART inhaler?

MART asthma attack advice

How are MART inhalers different from other combination inhalers?

Who benefits from using a MART inhaler?

Possible side effects of MART 

“Maintenance and Reliever Therapy (MART) is when you have just one inhaler which contains a combination of medicines to help your asthma,” says Dr Andy Whittamore, Asthma UK's in-house GP. 

“MART inhalers include a steroid preventer medicine and a certain type of long-acting bronchodilator medicine which can also be used as your emergency reliever. Not all combination inhalers can be used as a reliever so check with your GP.”

When to take your MART inhaler

You need to take your MART inhaler:

  • Every day, even when you’re feeling well. This helps prevent the inflammation in your airways long term so you’re less likely to react to asthma triggers.
  • if your symptoms get worse, like coughing, wheezing or breathlessness, or if you’re having an asthma attack. This helps calm down your symptoms quickly.

“If your symptoms get worse at any point during the day you can take up to the maximum dose agreed with your GP or asthma nurse. This should be written in your MART action plan,” says Dr Andy.

“When you take your MART inhaler, you get a dose of a fast-acting medicine called formoterol to help your symptoms quickly. At the same time you also get a dose of steroids to help dampen down the inflammation and swelling in your airways.”

Do I need a blue reliever inhaler as well as my MART inhaler?

A MART inhaler can be used as your reliever inhaler too. This means you probably won’t need another separate reliever inhaler.

“However, MART inhalers may not be ideal for everyone when they’re having an asthma attack,” says Dr Andy. 

“Some people find it hard to get dry-powder medicines deep enough into their lungs. So sometimes the GP or asthma nurse may suggest a separate reliever inhaler they can use with a spacer for emergency situations.Talk to your doctor about the best options for you.”

MART asthma attack advice

“If you're on a MART regime your GP or asthma nurse should tell you what to do during an asthma attack. Make sure you have a written asthma action plan specifically for the MART therapy you're on,” says Dr Andy.

“If you're still not sure what to do in an asthma attack, speak to your GP or asthma nurse as soon as possible.”

The asthma attack information on this website is not designed for people using MART regimes.

How are MART inhalers different from other combination inhalers?

The main difference is that, unlike other combination inhalers, MART inhalers also work as a reliever inhaler.

So you can use your MART inhaler when your symptoms come on as well as taking it every day as prescribed. This means that you may not need a separate reliever inhaler if you’re on the MART regime.

“Remember that other combination inhalers can’t give quick relief for your asthma symptoms,” says Dr Andy. “So you still need to use your usual reliever inhaler too.

“If you’re not sure whether your combination inhaler can be used as a reliever inhaler, speak to your GP, pharmacist or asthma nurse.”

Common brands of MART inhalers in the UK include:

  • Symbicort
  • Fostair
  • DuoResp Spiromax
  • Fobumix Easyhaler

Who might benefit from using a MART inhaler?

MART inhalers are 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 for you if:

  • you’re still getting asthma symptoms even though you’re taking your preventer inhaler as prescribed

Some of the benefits of MART you might notice are: 

  • you're more likely to remember to use your inhaler (it’s easier to only have to use one inhaler rather than two)
  • you need to take less inhaled steroids to control your asthma symptoms and prevent asthma attacks
  • you have cheaper prescription costs because you don't need to collect separate reliever and preventer inhalers.  

Possible side effects of MART

As with the combination inhalers, there's not as much evidence about side effects specifically for MART regimes. It's likely that any side effects will be the same as for the preventer and reliever inhalers.

However, people on MART regimes may be on higher doses of asthma medicines and being on a higher dose can increase the risk of having side effects from the medicine.

It's really important to go to your annual asthma review and other regular appointments so that your GP or asthma nurse can go through your asthma action plan with you and check how well your asthma is being controlled.

Need more help about MART inhalers?

If you have more questions about MART regimes, please speak to your GP or asthma nurse.

You can also call the Asthma UK Helpline on 0300 222 5800 (Mon-Fri 9am-5pm). Or message them via WhatsApp on 07378 606 728.

Last updated October 2019

Next review due October 2022