Adoption and implementation of maintenance and reliever therapy for adults with moderate-to-severe asthma

The use of single-combination inhaled corticosteroid and long-acting bronchodilator for maintenance and relief therapy (MART) significantly reduces asthma exacerbations and has been incorporated into asthma guidelines since December 2020, but there are limited data regarding the implementation of this approach to asthma management. To determine the frequency at which MART was recommended to patients with moderate-to-severe asthma being seen at subspecialty pulmonary and allergy practices at an academic healthcare system, and the patient and clinician characteristics associated with the use of MART. We conducted a retrospective cross-sectional study of the electronic medical records of an academic healthcare system in the Northeastern United States between January 2021 and October 2023. Patient demographic and clinician data were collected, and MART recommendation was confirmed by chart review. We assessed the relationships among patient demographics, clinician characteristics, and MART recommendation. Of 2016 patients reviewed, 293 (14.5%) were recommended MART, with 255 (87%) concurrently prescribed short-acting bronchodilators. Patients on inhaled corticosteroid-formoterol at baseline were significantly more likely to be recommended MART, whereas older patients and those on Medicare were significantly less likely to be recommended MART; 22 of 50 clinicians (44%) did not recommend MART ever, and only 3 clinicians recommended MART to 30% to 60% of their patients. Clinicians who were part of the asthma group were significantly more likely to recommend MART. Among academic subspecialty clinicians, there has been limited implementation of MART, with a small number of clinicians adopting MART routinely and more than 40% of clinicians not recommending it.