One Inhaler for Prevention and Relief? MART and AIR Asthma Treatment Explained

For years, most people with asthma in India have been told the same thing: use your brown or orange preventer every day, and keep a blue reliever in your pocket or purse for emergencies. So when a doctor says, “From now on, you only need one inhaler for both,” it can feel confusing, even a little scary. If you have heard the term and wondered what a MART inhaler asthma plan really means, or what AIR treatment is, this guide is for you.

We will walk through what MART and AIR stand for, how a single inhaler can both calm inflammation and relieve symptoms, who these plans are usually meant for, and the questions worth taking to your next appointment. The goal is not to change your treatment. It is to help you understand it, so you can have a better conversation with your doctor.

This article is general education, not medical advice. Everyone’s asthma and triggers are different. Please talk to your doctor about your own symptoms and treatment, and never start, stop or change any asthma medicine on your own.

1. The old two-inhaler routine and why it is changing

Asthma has two sides. There is the swelling and irritation inside the airways, called inflammation, which builds quietly over days. And there is the sudden tightening of the muscles around the airways, which causes wheezing, coughing and that heavy chest feeling.

Traditionally, these were treated separately:

• A preventer containing an inhaled steroid (also called an inhaled corticosteroid or ICS) to calm inflammation over time.
• A blue reliever, usually salbutamol, to open the airways quickly when symptoms flare.

The problem is that many people lean on the blue inhaler because it works fast and they feel better within minutes. The preventer gets skipped on busy days because it does not give that instant feeling. Over time, the inflammation keeps simmering in the background, even when the blue inhaler makes things feel fine. Our guide on why you should take medication as part of asthma prevention explains why that daily, quiet treatment matters so much.

This is why current asthma guidelines now favour an approach where every dose of relief also brings some anti-inflammatory medicine. That is the idea behind MART and AIR.

2. What is MART and what is AIR?

MART: maintenance and reliever therapy

MART stands for maintenance and reliever therapy. It is often called single inhaler therapy. You use one combination inhaler in two ways:

• Maintenance: a fixed number of puffs every day, usually morning and evening or once a day, as your doctor prescribes.
• Reliever: extra puffs from the same inhaler when you get symptoms like wheezing, coughing or breathlessness.

Because the same inhaler does both jobs, many people on MART do not need a separate blue inhaler. Your doctor will tell you clearly whether you still need one.

AIR: anti-inflammatory reliever therapy

AIR stands for anti-inflammatory reliever. Here, the combination inhaler is used only when you have symptoms, with no fixed daily puffs. It is generally meant for people with milder asthma, where the doctor feels regular daily maintenance doses are not needed.

In both cases, every time you reach for relief, you also get a small dose of inhaled steroid to calm the airways. That is the big difference from a blue inhaler alone.

3. How a MART inhaler asthma plan works day to day

Here is what a typical day can look like for someone who has been put on MART by their doctor. The exact number of puffs is always decided by the doctor and written in your action plan.

• Morning: take your prescribed maintenance puffs, ideally at the same time every day, such as after brushing your teeth.
• During the day: if you start wheezing on a dusty commute or coughing after climbing stairs, take a reliever puff from the same inhaler, as your plan describes.
• Evening: take your evening maintenance puffs if your plan includes them.
• After each use: rinse your mouth with water and spit it out, which helps reduce hoarseness and mouth infections from the steroid.

The daily limit matters

Your doctor will set a maximum number of puffs you can take in a day, counting both maintenance and reliever puffs together. Write this number down and keep it in your action plan. If you find yourself needing more reliever puffs than usual for a few days, or getting close to that limit, it is a sign to contact your doctor, not to keep going on your own.

Why one inhaler can do both jobs

This works because of a medicine called formoterol. Formoterol is a bronchodilator that starts opening the airways within minutes, much like salbutamol, but its effect also lasts for many hours. When it is combined with an inhaled steroid such as budesonide or beclometasone, the inhaler can act as a quick reliever and a preventer at the same time. A formoterol reliever plus steroid in one device is the heart of both MART and AIR.

4. Not every combination inhaler can be used this way

This is the most important point in this article. Combination inhalers are very common in India, and many of them look similar. But only some can be used for MART or AIR.

• Suitable: inhalers that combine an inhaled steroid with formoterol, in the specific strengths and devices your doctor approves for this purpose.
• Not suitable: combinations with salmeterol or vilanterol. These are long-acting too, but they are not meant to be used as quick relievers, so they should never be used for extra puffs during symptoms.
• Not the same: a blue salbutamol inhaler on its own does not contain any steroid, so it does not give the anti-inflammatory benefit.

Even among formoterol combinations, not every strength or device is meant for MART. That is why switching on your own, or using a friend’s or relative’s combination inhaler “because it is the same medicine,” can be risky. If you are ever tempted, please read our piece on why it is important to avoid self-medication in asthma.

Rotacaps, MDIs and devices common in India

In India, formoterol combination medicines come in different forms, including metered dose inhalers (the press-and-breathe kind) and dry powder capsules called rotacaps that you load into a small device. Each needs a different technique:

• Metered dose inhaler: a slow, steady breath in, often with a spacer for better delivery. See our spacer guide for using and cleaning one.
• Rotacaps or dry powder devices: a quick, deep, strong breath in, with no spacer. Store capsules in a dry place, especially during the monsoon.

Whichever device you use, good technique decides how much medicine actually reaches your lungs. Our article on inhaler technique fixes for 7 common errors is worth a quick read before your next refill.

5. Who might MART or AIR suit, and who might it not?

Only your doctor can decide whether single inhaler therapy is right for you. In general, it is commonly considered for:

• Teenagers and adults whose asthma is not well controlled on separate preventer and reliever inhalers.
• People who rely heavily on their blue inhaler and often forget or skip their preventer.
• People with milder asthma, where AIR may be considered instead of a blue inhaler alone.
• Some children, depending on their age, the inhaler strength and the doctor’s judgement.

It may not be the right fit for everyone. Some people do well on their current plan, some have other medical conditions to consider, and some find a different device easier to use. If your symptoms keep coming back, our checklist of signs your asthma is not well controlled can help you notice patterns to share with your doctor.

6. Questions to ask your doctor about single inhaler therapy

Take this checklist to your next appointment, or save it on your phone:

• Is MART or AIR suitable for my type of asthma?
• Is my current combination inhaler one that can be used for relief, or only for daily maintenance?
• How many maintenance puffs should I take, and when?
• How many reliever puffs can I take at one time, and what is my maximum in a day?
• Do I still need to carry a blue inhaler?
• What should I do if I am using more reliever puffs than usual?
• Can you check my inhaler or rotacap technique today?
• Can we update my written asthma action plan for this new routine?

A written plan makes all of this much easier to follow, especially for family members who may need to help in an emergency. Here is how to develop an asthma action plan step by step.

Common side effects to mention

Like any medicine, formoterol combinations can have side effects in some people, such as a shaky feeling, a fast heartbeat, a hoarse voice, a sore throat or white patches in the mouth. Rinsing after use helps with some of these. If anything worries you, tell your doctor rather than stopping the inhaler yourself.

7. When to seek urgent help

A single inhaler routine does not replace emergency care. Know the warning signs.

Call 112 or go to the nearest emergency department if

• You are struggling to breathe, or too breathless to speak in full sentences.
• Your lips, tongue or fingertips look blue or grey.
• You feel very drowsy, confused or exhausted.
• Your reliever puffs are not helping, or the relief does not last.
• You have reached the maximum daily puffs your doctor set and still have symptoms.

While you wait for help, sit upright, stay as calm as you can, and follow the emergency steps in your action plan.

See your doctor soon if

• You are waking at night with cough or wheeze.
• You need extra reliever puffs on most days or for several days in a row.
• Your inhaler seems to be running out faster than usual.
• You are unsure which inhaler is for what, or whether you are using it the right way.

Siddhant’s POV: Understanding your inhaler is part of breathing easier

I have lived with asthma for more than 30 years, and over that time I have seen how much confusion there can be around inhalers. Which one is for every day, which one is for emergencies, and which ones look alike but work differently.

My breathing improved after I moved from Delhi NCR to Dehradun. That change taught me that good asthma control comes from many small things working together: the air around us, the routines we follow and the medicines our doctors choose for us.

If I could share one thought, it would be this: never feel shy about asking your doctor to explain your inhaler again, even if you have been using one for years. Ask what each puff is for, ask about your daily limit, and ask for it in writing. Understanding your treatment is not a small thing. It is part of feeling in control.

Siddhant Jain, founder of Asthma Friend, living with asthma for 30+ years

Conclusion

MART and AIR are ways of using one combination inhaler, containing an inhaled steroid and formoterol, so that every dose of relief also helps calm airway inflammation. With MART, you take regular daily puffs plus extra puffs for symptoms. With AIR, you use it only when symptoms appear. These plans only work with specific formoterol combinations, never with salmeterol or vilanterol inhalers, and always within the daily limit your doctor sets. If single inhaler therapy sounds interesting, or if you have already been switched and feel unsure, take your questions to your doctor and ask for an updated written action plan.

Take the next step with Asthma Friend

• Join our community: Connect with people who understand life with asthma at Asthma Friend.
• Learn through play: Explore free educational games at Asthma Friend Games.
• Create your free asthma action plan: Use the Asthma Friend Action Plan Generator and review it with your doctor, including your daily puff limit.

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