AIR and MART approach to asthma treatment

Collaboration between the British Thoracic Society, National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network has resulted in a joint asthma guideline on the diagnosis, monitoring and management of chronic asthma. This marks a significant change in approach and brings the national asthma guideline in line with many of the recommendations made by the Global Initiative for Asthma. It is widely recognised that poor adherence to regular preventer treatment and overreliance on short-acting beta-2 agonists (SABAs), as highlighted by the recent Medicines and Healthcare products Regulatory Agency alert, may mask disease progression, leading to severe exacerbations with an increased risk of hospitalisation and mortality. To combat this, the national asthma guideline now advocates anti-inflammatory reliever (AIR) as the first step in those aged over 12 years. The guideline also promotes the use of maintenance and reliever therapy (MART) as second-line treatment or first-line for newly diagnosed asthma (in highly symptomatic patients or those presenting with a severe exacerbation). AIR and MART regimens ensure that patients receive both fast-acting formoterol and an inhaled corticosteroid with every dose, thereby treating the acute symptoms while also targeting the underlying airway inflammation respectively. AIR and MART provide potentially simpler asthma treatment plans for patients as they can be titrated according to patient needs, thereby addressing the overreliance on SABAs. Also, they reduce the carbon footprint associated with inhaler use by replacing the need for two inhalers (reliever and preventer).