Act early to prevent worsening asthma in pregnancy

Current and past asthma control and severity can predict future asthma exacerbations during pregnancy, emphasising the importance of optimal asthma management in young women.

In a study of 1,461 women from three asthma in pregnancy cohorts conducted in 2004-2006 and 2007-2010, 9.2% of women experienced an asthma exacerbation defined as worsening of asthma requiring hospitalisation, ED presentation or a course of oral corticosteroids (OCS).

The study found baseline asthma control was significantly worse in women who later experienced an exacerbation (p=0.001).

Asthma exacerbations before pregnancy were also associated with more exacerbations during pregnancy (p<0.001).

Those women with good inhaler technique (p=0.016) and a written asthma action plan (p = <0.001) – suggestive of optimisation of asthma management due to previous frequent or severe asthma attacks – were also more likely to experience exacerbations.

The study, published in The Journal of Allergy and Clinical Immunology: In Practice, also found women who used higher doses of ICS (>500 µg/day) were more likely to have an exacerbation than women who did not use ICS or used lower doses (p<0.001).

“For both outcome definitions, medium/high ICS dose and history of asthma exacerbations in the past 12 months were most strongly associated with exacerbations,” the study said.

The researchers said the findings were consistent with previous studies which have also identified more severe asthma as a risk factor for future exacerbations.

“This suggests that despite high dose ICS (and often ICS/LABA) and optimal management including a written asthma action plan and education, women with more severe asthma have more severe exacerbation in pregnancy,” they said.

“While it is likely that exacerbation rates would be even higher without appropriate treatment and optimal management, it clearly highlights the need to promote research that trials safe asthma treatments and management approaches in pregnancy that could more effectively reduce asthma exacerbations.”

The study also found that multiparity was associated with severe exacerbations.

Gastrointestinal reflux and food triggers were not significant in the final models but the trends suggested more research was warranted regarding risk factors for exacerbations during pregnancy.

Co-investigator on the study Dr Vanessa Murphy, from the Hunter Medical Research Institute, told the limbic that most exacerbations occur during the second trimester of pregnancy.

She said guidelines recommended regular asthma monitoring in pregnancy every 4-6 weeks.

“The additional consideration in pregnancy is the fact that asthma symptoms can get worse in pregnancy. So certainly clinicians should focus on women with a history of more frequent, less controlled asthma, and previous exacerbations but it is possible in pregnancy for women with mild asthma to have flare ups.”

“So it’s good to optimise early in pregnancy ahead of that second trimester peak.”

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