Respiratory/ICS/formoterol & LABA (AIR/MART)

ICS/formoterol (AIR / MART) & LABA

also: formoterol · salmeterol · MART · AIR · Symbicort · Fostair

Overview

The centrepiece of the 2024 asthma overhaul — a combined ICS/formoterol inhaler used as the reliever (AIR) and, with regular dosing, as maintenance + reliever (MART). LABAs must never be used without an ICS.

Mechanism

Formoterol is a long-acting β₂-agonist with a FAST onset → usable as a reliever; combined with an inhaled corticosteroid so every reliever puff also delivers anti-inflammatory treatment. Salmeterol is a slow-onset LABA (maintenance only).

Indications

Asthma — first-line per NG245 (as-needed AIR → MART)
COPD (LABA, usually with LAMA ± ICS)

The agents

Budesonide/formoterol (e.g. Symbicort, Fostair)ICS/formoterol — AIR/MART

NG245 asthma ladder: as-needed AIR → low-dose MART → moderate MART.

Salmeterolslow-onset LABA

maintenance only

Never as a reliever; never without ICS.

Adverse effects

As β₂-agonists: tremor, palpitations, hypokalaemiacommon

LABA without ICS → increased asthma deathserious

The reason LABA monotherapy is contraindicated in asthma.

Cautions & contraindications

LABA monotherapy in asthmaall

Increased asthma mortality — must be with an ICS.

Interactions

Hypokalaemia with diuretics/theophylline/steroids

Monitoring & kinetics

Asthma control / exacerbations; inhaler technique

Inhaled. NG245 adult ladder: as-needed AIR → low-dose MART → moderate-dose MART → add LTRA or LAMA → specialist.

Source: NICE NG245 — Asthma · BNF — Beta2-agonists (LABA)