Relationship Between Changes in Inhaled Corticosteroid Use and Markers of Uncontrolled Asthma During Pregnancy

Blais, Lucie; Firoozi, Faranak; Kettani, Fatima-Zohra; Ducharme, Francine M; Lemière, Catherine; Beauchesne, Marie-France; Bérard, Anick

doi:10.1002/j.1875-9114.2012.01091.x

Cited by 11 publications

(16 citation statements)

References 34 publications

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“…Severe asthma increases the requirement for ICS treatment and asthma severity increases the risk of an exacerbation. In our cohort, women with recurrent loss of control are probably similar to findings from previous studies [25] in that ICS use is a reflection of asthma severity, and therefore, they are more susceptible to worsening disease in pregnancy especially if there is a lack of compliance with medication. Previous work has demonstrated that cigarette use in pregnancy is associated with worsening asthma and an increased incidence of exacerbations [15], which may also apply to an increased risk of loss of control as demonstrated in this study.…”

Section: Discussionsupporting

confidence: 88%

“…Aside from all the problems associated with social disadvantage, the risks for a loss of control were age, BMI, cigarette use and ICS use, which are similar to previous studies examining risk factors associated with exacerbations [5]. A population-based study of 4434 asthmatic women examined ICS treatment pre-pregnancy and during pregnancy [25]. It was found that 50% of all women stopped or reduced their ICS intake with pregnancy and 8.2% exacerbated with cessation, while 20% of all other women exacerbated.…”

Section: Discussionsupporting

confidence: 59%

“…It was found that 50% of all women stopped or reduced their ICS intake with pregnancy and 8.2% exacerbated with cessation, while 20% of all other women exacerbated. Women using ICS were more likely to exacerbate, which is due to the confounder of asthma severity [25]. Severe asthma increases the requirement for ICS treatment and asthma severity increases the risk of an exacerbation.…”

Section: Discussionmentioning

confidence: 99%

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Patterns, predictors and outcomes of asthma control and exacerbations during pregnancy: a prospective cohort study

et al. 2016

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There exists a paucity of data for socially disadvantaged populations describing patterns and predictors of asthma control status and exacerbations during pregnancy, and their relationship to adverse perinatal outcomes.Asthmatic women (n=189) were followed prospectively during pregnancy, with visits at 12, 20, 28 and 36 weeks gestation. Data on loss of control, recurrent uncontrolled asthma and moderate/severe exacerbations were collected at each visit and their relationship to perinatal outcomes examined following stratification for fetal sex.50% of asthmatic women experienced a loss of control or moderate/severe exacerbation during pregnancy, with 22% of women experiencing a moderate/severe exacerbation. Factors associated with an increased risk of women experiencing recurrent uncontrolled asthma during pregnancy included smoking (relative risk 2.92, 95% CI 1.53–5.58), inhaled corticosteroid use at the beginning of pregnancy (relative risk 2.40, 95% CI 1.25–4.60) and increasing maternal age (relative risk 1.06, 95% CI 1.01–1.11). No factors were associated with moderate/severe exacerbations. Asthma control rather than exacerbations during pregnancy appeared to be most strongly correlated with perinatal outcomes. Following stratification by fetal sex, the presence of recurrent uncontrolled asthma was associated with an increased risk of being small for gestational age in women pregnant with females (33.3% versus 9.5%; p=0.018). In contrast, there was a nonsignificant increased risk of preterm birth in women with recurrent uncontrolled asthma that were pregnant with males (25.0% versus 11.8%; p=0.201)These results suggest that the key to improving perinatal outcomes lies in improving asthma control as early as possible in pregnancy and monitoring throughout pregnancy, rather than focusing on preventing exacerbations alone.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

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Patterns, predictors and outcomes of asthma control and exacerbations during pregnancy: a prospective cohort study

et al. 2016

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“…The change in dispensed ICS prescriptions before, during and after pregnancy was reported from 12 databases (Table ) in eight publications . Two studies collected data on ICS use before, during and after pregnancy using comparable methods and therefore were pooled for analysis/reporting (data from eight European databases).…”

Section: Resultsmentioning

confidence: 99%

“…Of the six database studies that could not be included in the pooled analysis due to differences in data collection, two used the same Korean data set but examined different outcomes . The first, by Koo et al reporting on 115 169 pregnant women with asthma, assigned ranks to controller medication for asthma, with low ranks (“1” and “2”) for ICS only inhalers and low ICS dose combination inhalers, rank “3” for medium‐to‐high ICS dose combination inhalers and the highest rank “4” to OCS .…”

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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Association between the timing of asthma diagnosis and medication use during pregnancy

et al. 2021

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Asthma medication use during pregnancy is recommended by international guidelines to maintain control of symptoms since poor control has been shown to increase the risk of adverse perinatal outcomes. To date, no studies have evaluated the association between the timing of new-onset asthma and the use of asthma medications during pregnancy. The objective of this study is to assess whether asthma medication use during pregnancy differs in women with asthma diagnosed during the first 19 weeks of pregnancy compared to those diagnosed 2 years before pregnancy. We conducted a retrospective cohort study using the Quebec asthma and pregnancy database. The primary outcome was the use of inhaled corticosteroids (ICS), ICS/long-acting ß2agonists (LABA) and short-acting ß2-agonists (SABA) during pregnancy defined as the number of filled prescriptions from 20 weeks of pregnancy (Cohort entry-CE-) until delivery. Oral corticosteroids (OCS) use during pregnancy was defined as the number of days of filled prescriptions from CE until delivery. Poisson regression models were used to compare the rates of asthma medication use between women diagnosed before and early in pregnancy, while adjusting for potential confounders. The secondary outcomes were the treatment dispensed at diagnosis defined as asthma medications filled at the pharmacy in the month prior and the month following the date of asthma diagnosis and adherence to ICS during follow-up estimated with the proportion of days covered (PDC). The cohort included 1 731 women with asthma diagnosed before and 359 early in pregnancy.

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Relationship Between Changes in Inhaled Corticosteroid Use and Markers of Uncontrolled Asthma During Pregnancy

Cited by 11 publications

References 34 publications

Patterns, predictors and outcomes of asthma control and exacerbations during pregnancy: a prospective cohort study

Patterns, predictors and outcomes of asthma control and exacerbations during pregnancy: a prospective cohort study

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

Association between the timing of asthma diagnosis and medication use during pregnancy

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