AIR vs MART Therapy in Asthma Management
The key difference between Asthma Inhalation Regimen (AIR) and Maintenance And Reliever Therapy (MART) is that MART uses a single ICS-formoterol inhaler for both maintenance and as-needed relief, while AIR uses separate inhalers for maintenance and relief.
Understanding AIR Therapy
AIR (Asthma Inhalation Regimen) follows the traditional stepwise approach to asthma management:
- Maintenance medication: Daily inhaled corticosteroids (ICS) or ICS-LABA combinations at fixed doses
- Reliever medication: Separate short-acting beta-agonist (SABA) inhaler used as needed for symptom relief
- Treatment adjustments: Based on symptom control and risk assessment
This conventional approach requires patients to use two different inhalers:
- Controller inhaler (ICS or ICS-LABA) taken regularly regardless of symptoms
- Reliever inhaler (SABA) taken only when experiencing symptoms
Understanding MART Therapy
MART (Maintenance And Reliever Therapy) represents a newer approach:
- Single inhaler: Uses a combination of ICS and fast-acting LABA (specifically formoterol) for both maintenance and relief
- Dual purpose: The same inhaler is used for scheduled daily doses AND as-needed symptom relief
- Evidence-based: Shown to reduce severe exacerbations while providing similar day-to-day control compared to traditional approaches 1
MART typically uses budesonide-formoterol or beclomethasone-formoterol combinations, as formoterol has a rapid onset of action similar to SABAs.
Key Differences Between AIR and MART
| Feature | AIR | MART |
|---|---|---|
| Number of inhalers | Two (controller + reliever) | One (combined purpose) |
| Reliever medication | SABA | ICS-formoterol |
| Maintenance medication | ICS or ICS-LABA | ICS-formoterol |
| Anti-inflammatory component in relief | No | Yes (ICS with each relief dose) |
| Positioning in guidelines | Traditional approach | Preferred option in 2019 GINA [2] |
Benefits of MART Over Traditional AIR
- Reduced exacerbation risk: Each relief dose delivers additional anti-inflammatory medication (ICS)
- Simplified regimen: Single inhaler may improve adherence
- Lower total ICS dose: Often requires lower maintenance ICS doses 1
- Addresses inflammation early: Provides anti-inflammatory therapy at the earliest signs of worsening asthma
When to Consider MART
MART is particularly beneficial for:
- Patients with history of exacerbations despite regular ICS use
- Those with poor adherence to maintenance therapy
- Patients who rely heavily on SABA reliever use
- Those who would benefit from simplified regimens
According to the 2019 GINA guidelines, low-dose ICS-formoterol is now the preferred reliever option for patients prescribed maintenance and reliever therapy 2.
Implementation Considerations
When implementing MART:
- Patient education: Clear instructions about both scheduled and as-needed use
- Monitoring: Track frequency of as-needed doses as indicator of control
- Maximum doses: Establish clear limits on maximum daily doses
- Device consistency: Ensure patient can use the delivery device correctly
Conclusion
Both AIR and MART are effective approaches to asthma management, but MART offers the advantage of providing anti-inflammatory therapy with every reliever dose through a single inhaler. The 2019 GINA guidelines have positioned ICS-formoterol combinations as preferred reliever options, representing a significant shift toward the MART approach in asthma management 2.