Latest advances in asthma treatment

MART Treatment

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

Several types of combination inhalers can be used safely for MART. These may be dry powder inhalers, or metered dose inhalers. Not all combination inhalers can be used for MART, only those with an inhaled steroid and a bronchodilator medicine called Formoterol.

If you are unsure which kind of combination inhaler has been prescribed, speak to your GP, asthma nurse or pharmacist.

A MART inhaler will:

• reduce inflammation in the airways.
• prevent asthma symptoms such as breathlessness and a tight chest.
• act quickly to deal with symptoms or help during an asthma attack.
• lower your risk of an asthma attack or flare up where you need high doses of steroid tablets.

How is MART different to other combination inhalers?

Like other combination inhalers, a MART inhaler contains:

• a steroid preventer medicine to reduce inflammation in the airways.
• a long-acting bronchodilator medicine (LABA) to keep the airways open.
• but like unlike other combination inhalers, a MART inhaler uses a fast-acting LABA medicine called formoterol.

This means someone can use their MART inhaler to treat symptoms or during an asthma attack (rather than the blue inhaler usually used by the majority of people with asthma when experiencing an asthma attack).

When using the MART inhaler to relieve symptoms, the LABA opens the airways, and the preventer medicine treats the inflammation that’s causing the symptoms.

Not all combinations inhalers can be used to relieve symptoms.

With some combination inhaler treatment, they will still need to use a blue reliever inhaler to treat symptoms or if they have an asthma attack. However, their Healthcare Plan will indicate this.

When is a MART inhaler prescribed?

Your GP or asthma nurse may prescribe MART if:

• Someone has been taking your preventer medicine exactly as prescribed and is still getting symptoms or
• they’ve tried other add-on treatments and are still getting symptoms or
• that the patient, along with the doctor/nurse thinks they would find it easier to manage their asthma using just one inhaler which works as a preventer and reliever. (Rather than taking preventer medications to damp down the inflammation in the airways and using a blue reliever inhaler to open the airways in the case of an asthma attack or someone is experiencing asthma symptoms.

GPs mainly prescribe MART to adults with asthma (aged 18 or over). They may prescribe a MART inhaler to some children over 12 if their asthma is not well controlled.

How to use a MART inhaler

• every day as prescribed, usually twice a day
• if asthma symptoms get worse
• if someone who has been prescribed a MART inhaler is having an asthma attack.

Add-on treatments

Not everyone needs add-on treatments for their asthma. Most people manage well with a regular preventer inhaler, and a reliever inhaler when needed.

Doctors and asthma specialists usually consider other treatments if someone is taking their preventer inhaler exactly as prescribed but is still having symptoms and is unable to fully control their asthma. These additional treatments are known as ‘add-on’ treatments because the person takes them in addition to the preventer inhaler.

Before starting any extra medicines, the GP will check other options to help them manage their asthma more easily.

• The doctor will look at options to make it simpler for someone to stick to the treatment plan, such as changing when they take their inhalers. Or altering their medication to a different type of inhaler that might be easier for them to use.
• They will review how someone can take their inhaler more efficiently – a spacer or Volumatic device can help this, or by changing the type of delivery system.
• Medical staff can help individuals identify and avoid triggers for their asthma
• Healthcare professionals will try and help people to stop smoking, as this is likely to make asthma worse and can also stop the preventer medication from working.

If the person’s asthma is still difficult for them to control, then doctors will look at the following add-on treatments:

Long-acting bronchodilatorsA long-acting bronchodilator helps to open up the airways. It contains reliever medicines that last 12 hours. It can reduce the likelihood of asthma attacks.

They must continue to take the preventer inhaler as prescribed because long-acting bronchodilators cannot reduce inflammation in the airways. The preventer inhalers make it less likely that someone will experience an asthma attack.

The GP may prescribe a long-acting bronchodilator in a combination inhaler. This is one inhaler containing both the long-acting bronchodilator and your preventer medicine. However, they will still need the usual blue reliever inhaler too, to use if they get symptoms or experience an asthma attack.

MART

Some people are prescribed MART inhalers. These contain a certain type of long-acting bronchodilator medicine Formoterol, found in MART inhalers (Maintenance and reliever therapy). MART inhalers can give quick relief for asthma symptoms too. This means they can use the MART inhaler as an emergency reliever as well. Not all combination inhalers can be used for MART, only those with an inhaler steroid and the bronchodilator medicine called Formoterol.

Montelukast (Singulair)

Montelukast is a preventer tablet. It is a leukotriene receptor antagonist (LTRA). This kind of medicine helps reduce inflammation in the airways.

Unlike the preventer inhaler, montelukast does not contain steroids. They need to take it alongside the regular steroid preventer inhaler.

Steroid tablets

The GP may prescribe oral steroids (usually prednisolone) in addition to the usual asthma medicines. They typically prescribe these medications for a short period of time, especially if someone experiences increased exposure to asthma triggers, such as during the hay fever season or exam season (if stress is a trigger). The GP may also prescribe them if someone experiences asthma symptoms more often and has difficulty getting things back into control.

Steroids help to get symptoms under control in the short term, or if someone has had an asthma attack, by reducing the inflammation in the airways.

If someone frequently needs oral steroids, or needs to take them long-term, their GP should refer them to an asthma specialist to look at other ways to help manage the asthma.

Specialist treatments

If symptoms have not improved with all the additional measures, then they are usually referred to a specialist.

The specialist can do tests to diagnose severe asthma. They can look at other options such as monoclonal antibody treatments or bronchial thermoplasty.

What to do if you or someone you know has an asthma attack

To find out what to do if you or someone around you has an asthma attack, click here.