Patient and practitioner determinants to Maintenance and Reliever Therapy (MART) concordance in Asthma during the SENTINEL Project

Study Design: Qualitative
Disease Area: Respiratory
Funder: AstraZeneca
Sponsor: AstraZeneca
Chief Investigator: Dr Michael Crooks


Asthma is a common inflammatory condition that effects the airways in the lung leading sufferers to experience breathlessness, coughing and wheezing that typically varies overtime and is associated with airflow limitation. Inhaled corticosteroids (ICS; preventer inhalers) are the cornerstone of asthma treatment and should be used regularly to control airway inflammation. However, many patients become over-reliant on blue-reliever inhalers (short-acting beta agonists; SABA) that provide only temporary relief of symptoms and do not treat the underlying inflammation. Over-use of SABA inhalers is associated with increased risk of asthma attacks and has a negative impact on the environment.  

A different way of treating asthma is now advocated by guidelines and involves using a single combination inhaler as both preventer and reliever. This approach is called maintenance and reliever therapy (MART) and ensures that when asthma patients experience symptoms, and therefore use their inhaler as a reliever, they also receive an ICS, treating the airway inflammation. MART is known to reduce the risk of asthma attacks and may reduce the environmental impact of asthma and its treatment.  

In the first year (Nov 2020-Dec 2021), an intervention delivered through the SENTINEL Project resulted in >15k fewer SABA reliever prescriptions across participating primary care networks, when compared with the same months in the previous year. The SENTINEL intervention was co-designed with service providers, service users, and includes healthcare-facing (education, data monitoring and reporting) and patient-facing (targeted asthma reviews, patient support and education) elements.  

What we plan to do

The key element in delivering guideline-recommended care for asthma treatment is the appropriate use of MART. However, not enough is known about the barriers (preventative factors) and facilitators (supportive factors) to i) initial adoption of a MART approach in a patient with asthma and ii) persistent use of MART after it is first adopted, both with regard to practitioner and patient factors. In this study, we will interview 15 asthma patients (10 who have transitioned to MART and continue to use it, and 5 who transitioned but later ceased usage). In addition, we will interview 15 health care practitioners (e.g., GPs, practice nurses, secondary care specialists) responsible for the review of patients with asthma involved in the SENTINEL project. We will also identify any barriers and facilitators to other elements of the SENTINEL project. 

What we will achieve

Outcomes from the study will be a more extensive understanding of the patient and practitioner barriers and facilitators to the initial and continual use of MART. Understanding these factors will help to identify how patients and clinicians can be supported to increase MART use, with benefits expected for patients, health services, and the environment. The new evidence generated by this study will be used to inform the strategies embedded within the sentinel intervention, the broader health care environment, enhance the implementation of MART and improve patient compliance with prescribed medication. Collectively, this will improve persistence with this approach. In line with guidelines for the development of complex interventions, these learnings could facilitate the timely modification of the SENTINEL intervention and enhance its impact. This study also has significant potential to inform implementation strategies for a broader anti-inflammatory reliever therapy strategy in asthma. 

Chief Investigator

Prof Mike Crooks Senior Clinical Lecturer and Consultant in Respiratory Medicine - University of Hull and Hull University Teaching Hospitals

HHTU Study team

Saphsa Codling - Trial Manager
Paul Bradley - Trial Co-ordinator
Sarah Sumpter - Data Manager
Dr Chao Huang - Statistician
Prof Judith Cohen - Co-applicant
Amy Porter - Trial Administrator
John Turgoose - Information Systems Manager
Phil Best - Data Manager


Prof Judith Dyson Professor in Implementation Science - Birmingham University 

Email Address

Participating sites and their Project Investigators

  • Holderness Health - Helena Cummings

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