What Exactly is MART?
Maintenance and Reliever Therapy, or MART, is a treatment strategy for chronic respiratory diseases, primarily asthma and sometimes COPD. It simplifies the patient's medication regimen by combining two types of medication into a single inhaler: an inhaled corticosteroid (ICS) and a rapid-onset, long-acting beta-2 agonist (LABA), specifically formoterol. The therapy is often also referred to as SMART, which stands for Single Maintenance and Reliever Therapy, but both terms refer to the same concept.
The Dual Role of the MART Inhaler
Traditionally, patients with persistent asthma used a separate daily 'preventer' inhaler (containing a steroid) and an 'as-needed' 'reliever' inhaler (containing a short-acting bronchodilator). The MART approach consolidates these functions into one device, which a patient uses for both daily prevention and immediate symptom relief. This means less confusion and a streamlined routine.
How a MART Inhaler Works
The combination of medications within a MART inhaler provides a two-pronged attack on respiratory symptoms:
- Daily Maintenance: The inhaled corticosteroid (ICS) component works to reduce chronic inflammation in the airways, addressing the root cause of asthma over time. The patient uses the inhaler daily as prescribed, even when they feel well.
- As-Needed Reliever: The rapid-onset formoterol component acts as a fast-acting bronchodilator, quickly opening the airways during an asthma attack or worsening symptoms. This provides rapid relief, similar to a traditional blue rescue inhaler. Because each rescue dose also contains an anti-inflammatory steroid, it treats both the immediate symptom and the underlying inflammation.
Medications Used in MART
For MART to be effective, the long-acting beta-agonist (LABA) must be fast-acting. For this reason, formoterol is the only LABA approved for this therapy. Common inhalers prescribed for MART include:
- Budesonide/formoterol: Widely studied and prescribed, known by brand names such as Symbicort or Breyna.
- Mometasone/formoterol: Another combination available for this purpose, known by the brand name Dulera.
MART vs. Traditional Inhaler Therapy
| Feature | MART (Maintenance and Reliever Therapy) | Traditional Therapy (e.g., ICS + SABA) |
|---|---|---|
| Number of Inhalers | One combination inhaler (e.g., budesonide/formoterol) | Two separate inhalers: a daily preventer (ICS) and an as-needed reliever (SABA) |
| Medication for Relief | The same single inhaler, which contains both a fast-acting bronchodilator and an anti-inflammatory | A separate blue reliever inhaler containing only a fast-acting bronchodilator (like albuterol) |
| Mechanism of Relief | Provides immediate airway opening plus an anti-inflammatory dose with each puff, treating both the symptom and its cause | Only opens the airways during an attack; does not address the underlying inflammation |
| Reduction of Exacerbations | Proven to reduce the risk of severe asthma flare-ups more effectively for many patients | Less effective than MART in reducing severe exacerbations when a SABA is used as reliever |
| Patient Adherence | Simpler regimen with only one inhaler to track, potentially improving patient adherence | Requires managing and remembering to use two different inhalers, which can be challenging |
Benefits of Adopting a MART Strategy
Implementing a MART strategy offers several advantages for individuals managing asthma and, in some cases, COPD:
- Reduced Risk of Severe Exacerbations: Studies have shown that using a single MART inhaler can significantly lower the risk of severe asthma attacks compared to using a daily preventer and a separate rescue inhaler.
- Lower Overall Steroid Exposure: By delivering the steroid on an as-needed basis during flare-ups, MART can lead to a lower total inhaled corticosteroid dose over time compared to a fixed, higher daily dose, while still providing effective control.
- Improved Adherence: With a single inhaler for both functions, the treatment plan is simpler and easier for patients to follow consistently, reducing the risk of forgetting or misusing medications.
- Consistent Anti-inflammatory Treatment: Every time a patient uses their MART inhaler for symptom relief, they also get a dose of the anti-inflammatory medication. This continuously helps manage the inflammation that drives the underlying disease.
Limitations and Considerations
While MART is highly beneficial, it is not without its considerations:
- FDA Approval Status: Although widely recommended by global guidelines (like GINA) and approved in many countries, FDA approval for using formoterol-based inhalers as a rescue medication in a MART regimen has been a complex issue in the United States, impacting insurance coverage.
- Condition and Severity: MART is most often recommended for patients with moderate to severe asthma, though its use in mild asthma is also being explored. It is also used for specific cases of COPD.
- Patient Education: Correct technique and understanding are crucial for the effectiveness of any inhaler therapy. Healthcare professionals must provide clear instructions on how and when to use the MART inhaler for both daily and relief doses.
For more detailed information on asthma management guidelines and treatment protocols, consult an authoritative resource like the Global Initiative for Asthma (GINA) reports.
Conclusion
In summary, what is the meaning of Mart in inhalers is an elegant solution to a complex problem in respiratory care: combining maintenance and reliever functions into a single device. By addressing both the chronic inflammation and acute symptoms of asthma and similar conditions, MART simplifies treatment, improves patient adherence, and significantly reduces the risk of severe exacerbations. This innovative approach represents a major step forward in optimizing patient outcomes for chronic respiratory disease management.
