Pregnancy related treatment disparities of acute asthma exacerbations in the emergency department

McCallister, Jennifer W.; Benninger, Cathy; Frey, Heather A.; Phillips, Gary; Mastronarde, John G.

doi:10.1016/j.rmed.2011.05.015

Cited by 42 publications

(22 citation statements)

References 30 publications

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“…Self‐reported changes to asthma treatment were documented in five studies of pregnant women with asthma, using (online) questionnaires or interviews . In a survey of 102 pregnant women with asthma in Australian, 37% reported controller use prior to pregnancy, yet only 18% reported use during pregnancy .…”

Section: Resultsmentioning

confidence: 99%

Inhaled corticosteroid use during pregnancy among women with asthma: A systematic review and meta‐analysis

Robijn

Jensen

McLaughlin

et al. 2019

Clin Experimental Allergy

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Background Studies demonstrate the prescription rate for inhaled corticosteroids (ICS) decreases in early pregnancy, possibly increasing exacerbation risk. This could be related to non‐adherence to prescribed asthma medication or medication cessation by the patient or doctor. ICS use during pregnancy has not previously been summarized in a systematic review. Objective The aim of this systematic review and meta‐analysis was to evaluate the use of ICS during pregnancy among asthmatic women, specifically: (1) the prevalence of use, (2) changes of use during pregnancy compared with pre‐pregnancy and (3) medication adherence among ICS users. Methods We systematically searched literature in Embase, MEDLINE, CINAL and Cochrane, using terms related to asthma, pregnancy and medication use. All English articles reporting ICS among pregnant women with asthma were included. Prevalence, changes in ICS use during pregnancy and ICS adherence were pooled using STATA (version 15.0, StataCorp USA). Results A total of 4237 references were retrieved in the initial search. Screening and review led to the inclusion of 52 articles for one or more aims (Aim 1: N = 45; Aim 2, N = 13; and Aim 3, N = 5). The pooled prevalence of ICS use during pregnancy was 41% (95%CI 36%‐45%); 49% (95%CI 44%‐55%) in Europe, 39% (95%CI 32%‐47%) in Australia and 34% (95%CI 27%‐41%) in North America. In eight prescription databases, ICS prescription rates lowered in the first trimester of pregnancy, compared with pre‐pregnancy, increased in the second trimester and decreased in the third trimester. Five studies reported ICS adherence among pregnant women, using four measures of self‐reported non‐adherence. In two comparable studies, pooled ICS non‐adherence was 40% (95%CI 36%‐44%). Conclusions The prevalence of ICS use among pregnant women with asthma is 41% and varies widely between countries and continents, and prescription rates for ICS change throughout pregnancy. More studies are needed to investigate ICS adherence during pregnancy in women with asthma.

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Section: Resultsmentioning

confidence: 99%

Inhaled corticosteroid use during pregnancy among women with asthma: A systematic review and meta‐analysis

Robijn

Jensen

McLaughlin

et al. 2019

Clin Experimental Allergy

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“…Over a quarter of family physicians have said they would instruct their pregnant patients to decrease or discontinue asthma medication during pregnancy, when asthma was well controlled by current therapy [9], potentially jeopardizing asthma control. Pregnant women are also less likely to be treated with systemic corticosteroids for acute asthma exacerbations than non-pregnant women (50.8% versus 72.4%) [24]. …”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary approach to management of maternal asthma (MAMMA [copyright]): the PROTOCOL for a randomized controlled trial

et al. 2012

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BackgroundUncontrolled asthma during pregnancy is associated with the maternal hazards of disease exacerbation, and perinatal hazards including intrauterine growth restriction and preterm birth. Interventions directed at achieving better asthma control during pregnancy should be considered a high priority in order to optimise both maternal and perinatal outcomes. Poor compliance with prescribed asthma medications during pregnancy and suboptimal prescribing patterns to pregnant women have both been shown to be contributing factors that jeopardise asthma control. The aim is to design and evaluate an intervention involving multidisciplinary care for women experiencing asthma in pregnancy.Methods/designA pilot single-blinded parallel-group randomized controlled trial testing a Multidisciplinary Approach to Management of Maternal Asthma (MAMMA©) which involves education and regular monitoring. Pregnant women with asthma will be recruited from antenatal clinics in Victoria, Australia. Recruited participants, stratified by disease severity, will be allocated to the intervention or the usual care group in a 1:1 ratio. Both groups will be followed prospectively throughout pregnancy and outcomes will be compared between groups at three and six months after recruitment to evaluate the effectiveness of this intervention. Outcome measures include Asthma Control Questionnaire (ACQ) scores, oral corticosteroid use, asthma exacerbations and asthma related hospital admissions, and days off work, preventer to reliever ratio, along with pregnancy and neonatal adverse events at delivery. The use of FEV1/FEV6 will be also investigated during this trial as a marker for asthma control.DiscussionIf successful, this model of care could be widely implemented in clinical practice and justify more funding for support services and resources for these women. This intervention will also promote awareness of the risks of poorly controlled asthma and the need for a collaborative, multidisciplinary approach to asthma management during pregnancy. This is also the first study to investigate the use of FEV1/FEV6 as a marker for asthma control during pregnancy.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12612000681853)

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“…However, there has been recent evidence from studies in emergency departments that pregnant women with asthma were less likely to receive oral steroid treatment for their exacerbations compared with non-pregnant women with asthma [42]. In a retrospective study conducted in 2011, which compared emergency department treatment for acute asthma exacerbations in 123 pregnant asthmatic women and 123 non-pregnant asthmatic women, it was found that 72.4% of non-pregnant asthmatics were treated with oral corticosteroids (OCS), compared with only 50.8% of pregnant asthmatics (p = 0.001), whilst at discharge, 41% of pregnant asthmatics were prescribed OCS compared with 69.2% of non-pregnant asthmatics (p < 0.001) [42]. Interestingly, the rate of representation to the emergency department within a 2-week period was significantly higher in the pregnant asthmatics (9.7% compared with 2.5% of non-pregnant asthmatics, p = 0.026).…”

Section: Management Of Asthma During Pregnancy According To the 2008 mentioning

confidence: 99%

Maternal Complications and the Management of Asthma in Pregnancy

Vanders

Murphy

2015

Womens Health (Lond Engl)

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Pregnancy is a unique state requiring alterations in maternal physiology to accommodate the growing fetus. Whilst the maternal immune system is normally well adept at performing this task, the presence of immune disorders, such as asthma, often lead to pregnancy-related complications affecting both mother and baby. Australia has a high prevalence of asthma; with approximately 12% of pregnant women reported to have current asthma. Poor control of asthma is of far greater risk than the use of asthma medications. Being able to identify complications associated with asthma during pregnancy is of great importance in providing appropriate asthma management and medical care to these pregnant women, which may have lifelong consequences for their offspring.

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Pregnancy related treatment disparities of acute asthma exacerbations in the emergency department

Abstract: In this population of asthmatics presenting to a tertiary emergency department with acute asthma exacerbations, pregnant women were less likely to receive appropriate therapy with systemic corticosteroids.

Cited by 42 publications

References 30 publications

Inhaled corticosteroid use during pregnancy among women with asthma: A systematic review and meta‐analysis

Inhaled corticosteroid use during pregnancy among women with asthma: A systematic review and meta‐analysis

Multidisciplinary approach to management of maternal asthma (MAMMA [copyright]): the PROTOCOL for a randomized controlled trial

Maternal Complications and the Management of Asthma in Pregnancy

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