Maintenance and Reliever Therapy (MART)

Maintenance and Reliever Therapy (MART) is an asthma treatment plan where you use one combination inhaler instead of two separate preventer and reliever inhalers.

A MART inhaler has been shown to lower the risk of asthma symptoms and attacks.

It does this by: 

• reducing inflammation in your airways
• preventing asthma symptoms such as breathlessness and a tight chest
• acting quickly to deal with symptoms or an asthma attack
• lowering your risk of an asthma attack or flare up where you need high doses of steroid tablets.

There are several types of combination inhalers you can use on a MART treatment plan. 

These may be dry powder inhalers (DPIs), or metered dose inhalers (MDIs).

If your medicine comes in a MDI inhaler, use a spacer. This helps the medicine get to your airways. It also lowers your risk of common side effects. 

How is MART different to other combination inhalers?

Not all combination inhalers can be used for MART, only those with an inhaled steroid and a long-acting bronchodilator (LABA) medicine called formoterol. 

Because it contains formoterol you can use your MART inhaler if you get symptoms or have an asthma attack, without needing a blue reliever inhaler as well. 

When you use your MART inhaler to relieve symptoms:

• formoterol opens the airways quickly
• the steroid preventer medicine treats the inflammation that’s causing the symptoms.

If you’re not sure which kind of combination inhaler you’re using, speak to your GP, asthma nurse or pharmacist.

If you’ve just been diagnosed with asthma and you’re having regular symptoms, your GP will prescribe maintenance and reliever therapy (MART). 

Your GP or nurse may also prescribe MART if your asthma is not well controlled with other types of treatment, for example:

• an as-needed AIR inhaler
• a low-dose steroid preventer inhaler taken as prescribed
• a combination inhaler with a low-dose steroid preventer and long-acting bronchodilator (LABA).

You and your doctor or nurse can also talk about changing to a MART treatment plan if you think you’d find it easier to manage your asthma using just one combination inhaler that works as a preventer and reliever. 

MART is usually prescribed to adults (aged 12 and over). It may sometimes be prescribed to children aged 5-12 too.  
 

You use your MART inhaler:

• every day as prescribed, usually twice a day
• if your asthma symptoms get worse
• if you have an asthma attack.

Use your MART inhaler every day 

You need to take your MART inhaler every day as prescribed. This is usually one or two puffs every morning and evening.

You need to take your inhaler every day to prevent symptoms even when you’re feeling well.

Each puff of a MART inhaler gives you a dose of steroid preventer medicine and a dose of long-acting bronchodilator medicine.  

Using a MART inhaler reduces inflammation in your airways and keeps your airways open. You should notice you can breathe more easily.

Use your MART inhaler when you get asthma symptoms 

You may be used to taking a blue reliever inhaler when you get symptoms. But on a MART treatment plan, you can use your MART inhaler as your reliever too.

Your MART inhaler will quickly open up your airways.

Each time you use your MART inhaler as a reliever you also get a dose of steroid preventer medicine. This reduces the inflammation in your airways so you’re less likely to react to your asthma triggers.

Always carry your MART inhaler with you so you can quickly take a reliever dose if you need it.  

Ask your GP, asthma nurse, or pharmacist about the maximum number of puffs you can take each day. 

Use your MART inhaler if you have an asthma attack

You can use your MART inhaler if you have an asthma attack. This is because it contains a long-acting bronchodilator called formoterol, which can act quickly to open up the airways if you have an asthma attack.  

Each time you take your MART inhaler to relieve symptoms, you also get a dose of steroid preventer medicine. This calms the inflammation in your airways.

Remember to download your MART asthma action plan so you know how to look after your asthma every day and what to do if symptoms get worse.

All medicines can have side effects, but not everyone gets them. 

The common side effects of MART are the same as the side effects of a separate preventer and reliever inhaler, or a combination inhaler.

Common side effects (may affect up to 1 in 10 people) include:

•    thrush in your mouth or throat (oral thrush)
•    a hoarse voice.

You’re less likely to get these side effects if you always rinse your mouth with water after taking your inhaler. 

Less common side effects (may affect fewer than 1 in 100 people) include:
•    quicker heartbeat, or heartbeats that are more noticeable (palpitations) 
•    trembling (shaking)
•    feeling sick.

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

Whenever you start a new medicine, you should speak to 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.  

Read more about common concerns about asthma medicines.