Asthma is a long-term condition that affects the lungs, making it hard to breathe at times. While there’s no cure for asthma, millions of people live with it every day. According to the CDC, as of 2021, around 24 million people in the U.S. have asthma, and in 2020, nearly one million had to visit the emergency room due to asthma attacks.

Even with new medications available, asthma rates continue to rise, partly due to air pollution, which is hard to avoid. This makes managing asthma effectively more important than ever.

The Global Initiative for Asthma (GINA) recently updated its 2024 recommendations to help people manage their asthma better. It now advises against using inhalers that only contain albuterol (a rescue medication). Research shows that relying on albuterol alone can increase the risk of severe asthma attacks, hospital visits, and even death.

Instead, GINA recommends newer approaches to asthma treatment, like Maintenance and Reliever Therapy (MART). This approach focuses on managing asthma symptoms and the underlying inflammation in your lungs. Below, we’ll explain how these therapies work and why they might be the right choice for managing your asthma.

“What is MART?”

MART stands for Maintenance-and-Reliever Therapy. It uses inhaled corticosteroid (ICS) and formoterol to both relieve asthma symptoms and reduce inflammation in your lungs.

  • It combines two medicines in one inhaler.
  • It works as both a daily controller inhaler and a quick-relief inhaler for asthma symptoms.
  • This regimen replaces as needed albuterol inhaler
“What can be used for MART therapy?”
  • Generic: Budesonide/formoterol
  • Brand: Symbicort
“How does dosing work if only one inhaler is used for both maintenance and reliever?

The number of puffs and frequency determines dosing. For example, in adults, this is typically the dosing regimen for Symbicort below.

  • Low dose for Reliever Dose = 1 puff as needed
  • Low dose for Maintenance Dose = 1 puff twice daily

OR

  • Medium dose for Maintenance Dose = 2 puffs twice daily
“Who can use MART?”
  • It’s ideal for anyone who wants one inhaler for both daily maintenance and quick relief, reducing the burden of multiple inhalers.
  • Suitable for individuals 6 years and older. Talk to your doctor about options for younger children.
“What are the benefits of MART?”
  • Simplifies your inhaler routine by combining maintenance and rescue functions into one inhaler.
  • Reduces asthma attacks and hospital visits. Studies show MART therapy is linked to better outcomes compared to using albuterol alone.
“Why is MART preferred over maintenance and albuterol regimens?”
  • MART therapies are effective for managing asthma while simplifying treatment.
  • Overusing albuterol can reduce its effectiveness over time, making it less reliable when you need it most.
  • Frequent albuterol use can also cause unwanted side effects and does not address the underlying inflammation, which can lead to more severe asthma attacks over time.
  • By shifting your asthma regimen to Symbicort, you can achieve better asthma control with fewer complications.
“How doe budesonide/formoterol work?”
  • Budesonide is an inhaled corticosteroid that reduces inflammation in your lungs, helping prevent asthma symptoms.
  • Formoterol relaxes and opens your airways, similar to albuterol. However, formoterol works for up to 12 hours, providing longer relief than albuterol, which lasts about 4–6 hours.
“How do I know which type of inhaler is best for me?”

Check out Adam’s blog on “COPD: What Inhaler Is Best for Me?”. Although this blog is titled with “COPD,” the inhaler types also apply to inhalers used for asthma.

“Do I need to use my controller inhaler every day, even when I feel well?”

Yes! Using your controller inhaler daily, even when you feel well, helps keep lung inflammation under control. Over time, this reduces the frequency and severity of asthma symptoms.

“What is the maximum dose of Symbicort?”
  • Up to 12 puffs a day (this includes both maintenance and relief doses).
  • No more than 6 puffs per hour.
“How do I keep track of my inhaler usage?”
  • Keep reminders on your phone to remind you to take maintenance doses or leave sticky notes around the house to help you remember your inhaler schedule
  • One way to remember to take maintenance doses is to build it around a routine, such as taking a dose after brushing teeth.
  • Keep track of inhalations that you use in a day by noting it on your phone or on a sticky note
“How do I know if I’m using my inhaler correctly?”
  • Manufacturer websites have tutorials on how to use the inhaler
  • Ask the pharmacist to show you the right technique when you pick up your inhaler. Using the inhaler properly is essential for it to work effectively.
“What should I do if my symptoms are getting worse despite using my controller inhaler?”
  • Give the new inhaler a trial of 2–4 weeks to see if it improves your symptoms.
  • Seek medical attention if symptoms persist despite taking extra relief puffs as needed.
  • Contact your doctor if you need more than the maximum recommended puffs.
“Can I adjust my controller dose if my symptoms change?”

Talk to your doctor before adjusting your dose. They may recommend changes if your asthma has been well-controlled for 4–6 months.

Prepared by Annie Vong, PharmD Candidate 2025

References:
  1. Centers for Disease Control and Prevention. (2023, November). Most recent national asthma data. U.S. Department of Health & Human Services. Retrieved from https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm
  2. Global Initiative for Asthma. (2024). Global strategy for asthma management and prevention (2024 update). Retrieved from https://ginasthma.org/
  3. (2024). Asthma treatment and management. UpToDate. Retrieved from https://www.uptodate.com