New AIR/MART inhaler measure launched in OpenPrescribing and OpenPrescribing Hospitals

We’ve launched a new AIR/MART inhaler measure to monitor the impact of the changes introduced in the BTS/NICE/SIGN asthma guideline published in November 2024. The new measure is already live for both primary care and hospitals.

Why build this measure?

One of our users emailed to suggest that we build a measure to monitor how prescribing has changed following the publication of the BTS/NICE/SIGN asthma guideline in November 2024, which made significant changes to recommendations for asthma management. For the majority of patients, it recommends use of a combined inhaled corticosteroid (ICS) with formoterol under an AIR (anti-inflammatory reliever) or MART (maintenance and reliever therapy) regimen.

This measure focuses on AIR/MART inhalers, and helps track how practices, PCNs, ICBs and hospitals are adopting these newer treatment regimens. Identifying variation in uptake can help show where a review of local prescribing practice may be beneficial, with resulting actions potentially meaning more people will receive these recommended treatments.

What does the measure look at?

The measure divides ICS containing inhalers into two groups:

• AIR/MART group: inhalers licensed for AIR and/or MART. These are low and medium dose ICS/formoterol combination inhalers.
• Non-AIR/MART group: non-formoterol ICS/LABA combination inhalers (these are not suitable for reliever use) and high dose ICS/formoterol inhalers (licensed for maintenance therapy only).

Some inhalers may be used off-label for AIR/MART in clinical practice. However, for the purposes of this measure, these inhalers are included in the non-AIR/MART group.Triple therapy inhalers are excluded, as they are more commonly used in COPD.

The measure shows the proportion of corticosteroid-containing inhaler doses that fall into the non-AIR/MART group. As with other OpenPrescribing measures, this measure has been designed so that lower values are generally better, in this case indicating better alignment with the latest guideline recommendations. There will be some exceptions where non-AIR/MART prescribing remains appropriate, particularly for some children and people with well-controlled asthma.

Measure design

This measure was developed with input from members of our newly formed OpenPrescribing Advisory Group. Their feedback helped refine both the design of the measure and the accompanying explanation, particularly around which inhalers are included and excluded.

Explore your data

You can also use our analyse pages to investigate the use of medicines across primary and secondary care.

For example, you could explore the following trends in respiratory medicines:

• ICS monotherapy inhalers - Primary care / Hospitals
• Non-formoterol ICS/LABA inhalers - Primary care / Hospitals
• Biologics used in the treatment of asthma - Hospitals

You might also find our existing respiratory measures in primary care and hospitals useful.

Get in touch

As a small team of clinicians, academics, and software engineers, we build and launch measures quickly by working in an agile manner, openly describing our methods and code. If you have any comments on this measure or suggestions for further developments of our measures on OpenPrescribing or OpenPrescribing Hospitals, please get in touch at bennett@phc.ox.ac.uk.