British Thoracic Society, Scottish Intercollegiate Guideline Network. BTS/SIGN British Guideline on the Management of Asthma. 2019. https// (accessed 30 November 2023)

Chan PW, DeBruyne JA. Parental concern towards the use of inhaled therapy in children with chronic asthma. Pediatr Int. 2000; 42:(5)547-51

Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2022. https// (accessed 30 November 2023)

Greener Practice. Inhalers and the environment. 2021. https// (accessed 30 November 2023)

Hatter L, Bruce P, Beasley R. A breath of fresh AIR: reducing the carbon footprint of asthma. Journal of Medical Economics. 2022; 25:(1)700-702

Kponee-Shovein K, Marvel J, Ishikawa R Carbon footprint and associated costs of asthma exacerbation care among UK adults. Journal of Medical Economics. 2022; 25:(1)524-531

Levy ML, Bateman ED, Allan K Global access and patient safety in the transition to environmentally friendly respiratory inhalers: the Global Initiative for Asthma perspective. Lancet. 2023; 402:(10406)1012-1016

National Institute for Health and Care Excellence. NG 80: Asthma: diagnosis, monitoring and chronic asthma management. 2021. https// (accessed 30 November 2023)

National Institute for Health and Care Excellence. Scenario: newly-diagnosed asthma. 2023. https// (accessed 30 November 2023)

Weinstein SM, Pugach O, Rosales G, Mosnaim GS, Walton SM, Martin MA. Family chaos and asthma control. Pediatrics. 2019; 144:(2)

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

02 December 2023
Volume 5 · Issue 12


Maintenance and reliever therapy (MART) is one device, which serves as both preventer and reliever. In children and young people, the choice is more limited in terms of device and this is called Symbicort MART (SMART). One of the most common modifiable factors for optimal asthma control at any age is adherence to prescribed preventer therapy (British Thoracic Society(BTS)/Scottish Intercollegiate Guideline Network (SIGN), 2019). As young patients grow and take increasing responsibility for their own health, perfect adherence can feel impossible for the developing brain (and with this, the ability to effectively analyse risk). As health professionals, it can be easy to focus on the adherence issue as a failure to organise, and to assume all have the capacity to optimally administer a medication twice daily. What we are increasingly learning through the multiple health inequality and psychosocial workstreams is that there are families who are fundamentally less likely to achieve this, even with additional support from their health team, due to an actual or perceived inability to deal with the modifiable factors highlighted by BTS/SIGN.

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.

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