DGRefHelp - NHS Dumfries & Galloway
Directions:
One puff prn
Preparations:
Symbicort 200/6 Turbohaler
Duoresp 160/4.5
Max daily dose:
6 puffs but
Up to 12 puffs short term. Medical assessment recommended
Maintenance and reliever treatment (MART) and Anti-inflammatory Reliever (AIR) for asthma
Warning
- MART and AIR treatment uses the same inhaler for regular treatment and as required use - i.e. no salbutmol inhaler is prescribed
- Formoterol has an equivalent onset of action to salbutamol. Other LABAs can’t be used
- MART has been shown to be equivalent or better to traditional regimes with separate preventer and reliever but if patients drop themselves down to reliever only then ICS/formoterol PRN only has been shown to be as effective as regular ICS, wheras salbutamol alone has been shown to increase the risk of asthma exacerbation and death
- PRN only dosage of ICS/formoterol is now licenced in the UK as AIR. It is used widely worldwide and recommended by GINA (Global Strategy for Asthma Management and Prevention, 2021)
- MART and AIR is only licensed for aged 12 and over (Symbicort 200/6 and Fobumix Easyhaler 80/4.5, and 160/4.5 are both licensed inhalers for 12-18s).
- For patients who need to step up it is possible to use 2 puffs BD of high dose inhalers (Fobumix 320/9, Fostair 200/6 etc) but the PRN inhaler should remain the lower dose ICS/formoterol. This regime is not licenced but is recommended by GINA as an option for individual patients following discussion—it should rarely be required
- For patients who wish to step down the lowest step using Fobumix 80/4.5 is a reasonable minimal maintenance.
Directions:
1 puff BD (or 2 puffs OD) plus 1 puff PRNPreparations:
Fobumix 80/4.5 DPI
Symbicort 100/6 DPI
Max daily dose:
8 puffs but
Up to 12 puffs short term. Medical assessment recommended
Directions:
1 puff BD (or 2 puffs OD) plus 1 puff PRN
Preparations:
Fobumix 160/4.5 DPI Duoresp 160/4.5 DPI
Symbicort 200/6 DPI
Fostair 100/6 MDI; Luforbec 100/6 MDI; Bibefco 100/6 MDI
Fostair 100/6 Nexthaler
Max daily dose:
8 puffs but
Up to 12 puffs short term. Medical assessment recommended
Directions:
2 puffs BD plus 1 puff PRN
Preparations:
Fobumix 160/4.5 DPI Duoresp 160/4.5 DPI
Symbicort 200/6 DPI
Fostair 100/6 MDI; Luforbec 100/6 MDI; Bibefco 100/6 MDI
Fostair 100/6 Nexthaler
Max daily dose:
8 puffs but
Up to 12 puffs short term. Medical assessment recommended