Maintenance And Reliever Therapy (MART) for young people with asthma

When we consider family chaos in the context of a developing brain with limited abilities to create routine for itself, or to analyse risk (of not taking vs the benefit of taking medication), it is perhaps a little easier to understand why a simple task becomes difficult (Weinstein et al, 2019). When we consider further the financial, socioeconomic and psychological pressures on families who have, in the last 5 years, experienced a pandemic, pressures of balancing work and often round-the-clock childcare and then a cost of living crisis, it feels like many of our families have reached capacity on their mental load.

Anecdotally, it feels like asthma care has moved at great pace in the last decade, meaning that a large subset of our families have parents with asthma and/or atopy. They are likely to have initiated treatment when lone short-acting beta-agonists (SABA) were still recommended in the guidelines and, as is often found, feel the reliever is the medicine that ‘works’ and fear remains around inhaled steroids (Chan and Debruyne, 2000). The focus of the asthma narrative has been on reliever for some time and, despite guidelines switching to a preventer-focused approach and the health literature following suit, behaviour and perception change will be slower to catch up. We are at the tricky point of pursuing more proactive models of care with a patient population that is largely still thinking in a reactive way.