M19 MANAGEMENT OF UNCONTROLLED ASTHMA IN PREGNANCY CHALLENGES AND CONCERNS

Introduction Management of uncontrolled, moderate-to-severe asthma during pregnancy can be challenging. Despite advances in treatments, a limited evidence base and potential maternal and foetal risks can result in clinician uncertainty and anxiety amongst patients. Our aim was to describe our current practice and compare asthma at baseline and during pregnancy. 

Methods Retrospective review of patients attending a new dedicated asthma in pregnancy clinic at a large tertiary severe asthma service between December 2020 and March 2023. Standardised questionnaire results, adherence, exacerbation, and medication history was compared before and during pregnancy. A paired t-test was used to investigate differences in asthma control at baseline and during pregnancy. 

Results 47 women with 48 pregnancies were reviewed. Median age was 28 years (interquartile range, 26–32 years). Pre-pregnancy, most women were on a Global Initiative for Asthma treatment step 3–5 (42/48, 88%) and were considered to have uncontrolled asthma (an asthma control questionnaire (ACQ-6) score of ≥1.5 and/or ≥1 exacerbation requiring high dose steroids in the previous 12 months; 35/48, 73%). 12 women (26%) had documented anxiety about their asthma while pregnant, of which 4 women (4/12, 33%) admitted to stopping some or all their asthma treatments prior to coming to the first clinic appointment. A switch to a more suitable inhaled-device, dose increase, or addition of another controller was attempted in 23/48 (48%) pregnancies to optimise asthma. 6 (6/48,13%) pregnancies were associated with a deterioration of asthma, 9 (9/48, 19%) improved and 32 (32/48, 68%) women’s asthma control remained the same. Measures of asthma (ACQ-6, exacerbations, hospitalisations, short-acting bronchodilator collections) did not significantly change during pregnancy except for the mean mini-Asthma Quality of Life Questionnaire score (3.7±1.8 vs. 3.1±1.6, p=0.04) which decreased and mean percentage adherence which improved (65%±27 vs. 77%±22, p=0.03). 

Conclusions Asthma management during pregnancy is guided by asthma control pre-conception. Attending a dedicated asthma in pregnancy clinic is an opportunity to educate women, improve adherence and manage anxiety. Attempts to optimise treatment were not always successful, which may partly be due to other physiological mechanisms in pregnancy. Further qualitative research and improved education may be a patient-centred solution.