MART for Asthma

Basics of Asthma Control

The goals of asthma management are straightforward and clinically meaningful:

• The need for a reliever inhaler should be less than three times per week

• There should be no night-time symptoms

• There should be no limitation of daily activities

Symptoms that go beyond these suggest poor asthma control and warrant reassessment of treatment.

Asthma can be simply defined as a condition where, in response to known or unknown triggers, there is:

• Bronchoconstriction

• Airway inflammation

Effective management must address both of these components.

Standard Asthma Therapy

Traditionally, asthma treatment consists of two main components:

1. Preventer therapy

   • Inhaled corticosteroids (ICS)

   • Sometimes combined with leukotriene receptor antagonists

2. Reliever therapy

   • Short-acting bronchodilators

   • Used either separately or in combination, depending on disease severity

This conventional approach works well for many patients, but not all achieve good control with it.

What Is MART?

MART stands for Maintenance and Reliever Therapy.
It is also known as SMART — Single Maintenance and Reliever Therapy.

In MART:

• The same inhaler is used both as:

  • A daily maintenance (preventer) treatment

  • An as-needed reliever

This inhaler contains:

• An inhaled corticosteroid

• A long-acting beta-2 agonist, specifically formoterol

Why Is Formoterol Essential in MART?

Formoterol is the key bronchodilator used in MART regimens because:

• It has a rapid onset of action (within 2–3 minutes)

• It provides a long duration of effect (up to 12 hours)

This unique combination of fast relief and prolonged action makes formoterol suitable for both maintenance and relief. Other long-acting bronchodilators do not share this property, which is why formoterol is mandatory in MART combinations.

In the future, other bronchodilators with similar or improved properties may become available.

Who Should Be Treated with MART?

MART is not for everyone. Current recommendations suggest it for:

• Children above 5 years of age, adolescents, and adults

• Patients with moderate to severe asthma

• Those not well controlled on standard preventer and reliever therapy

• Patients who:

  • Require frequent use of reliever inhalers

  • Have had significant exacerbations, including hospital admissions or urgent medical interventions

Benefits of MART

Evidence strongly supports the use of MART in appropriate patients. Its advantages include:

• Improved compliance due to a single inhaler

• Clear and simplified treatment regimen

• Reduction in hospital admissions

• Reduction in asthma-related mortality

• Cost-effectiveness

• Eco-friendly, as it often uses metered dose inhalers

However, patients must always be provided with a clear, personalised asthma action plan when using MART.

Side Effects and Safety Considerations

Like all medications, MART can have side effects related to:

• Bronchodilators

• Inhaled corticosteroids

These are well-known and widely documented, and readers are encouraged to review standard references and guidelines for further detail.

Dosing Principles in MART

Although dosing is individualised, some basic rules apply:

• A standard twice-daily dose is used as maintenance therapy

• Additional doses of the same inhaler can be taken as a reliever

• Maximum total doses per day: 8

• Maximum puffs at one time: 6

If a patient requires:

• More than 8 doses in a day, or

• Maximum doses without symptom improvement

  Key Points When Prescribing MART

When starting a MART regimen, always ensure:

1. The patient has a clear personalised asthma action plan

2. Patients and parents understand that:

   • Excessive inhaler use is a warning sign

   • Lack of response despite maximum dosing requires urgent review

3. If patients or parents are worried about symptoms, they should seek medical help immediately

   EDUCATION

Multiple national and international guidelines support these principles, and several high-quality articles on MART are available for further reading.

What is "AIR" ?

It is simply MART regime used as "As and When Indicated" treatment. (Anti-inflammatory and Reliever Therapy".

Please do not forget- "Education is the key in the management of Asthma"