Fifteen-minute consultation: Maintenance and reliever therapy for the management of asthma in children and young people

Asthma is the most common chronic disease of childhood. Acute asthma attacks are a frequent reason for emergency presentation in children and young people (CYP), and fatal asthma attacks can occur even in those thought to have mild disease. Asthma treatment in the UK has until recently relied heavily on a strategy of regular 'maintenance' inhaled corticosteroid (ICS) and separate 'reliever' inhalers containing short-acting beta-agonist (SABA) taken as needed to relieve symptoms (most commonly relievers contain salbutamol). This strategy is vulnerable to poor adherence to maintenance treatment and over-reliance on SABA inhalers, both of which increase airway inflammation and the risk of asthma attack. An alternative strategy using a single fixed-dose inhaler combining ICS with a fast-onset long-acting beta 2-agonist (eg, formoterol) as either anti-inflammatory reliever (AIR) or as maintenance and reliever therapy (MART) is gaining support. In randomised controlled studies as well as pragmatic real-world studies in people with mild to moderate asthma, AIR and MART have been shown to be as effective as standard fixed ICS with as-required SABA and better than SABA-only treatment. Additionally, the Symbicort Turbohaler, th most-studied of the devices licensed for MART/AIR currently, is an inhaled powder device which does not require a spacer and is potentially more environmentally friendly compared with pressurised metered-dose inhaler and metered-dose inhaler devices while being equally effective. Our article aims to review some of the evidence base for AIR/MART in CYP, while giving practical guidance on how to incorporate them into paediatric asthma management.