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McLaughlin K, Jensen M, Foureur M, Murphy VE. Are pregnant women with asthma receiving guideline-recommended antenatal asthma management? A survey of pregnant women receiving usual care in Australia. Women Birth 2023; 36:108-116. [PMID: 35339413 DOI: 10.1016/j.wombi.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/08/2022] [Accepted: 03/17/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Asthma affects 12.7% of pregnant women in Australia. Key recommendations for asthma management during pregnancy include: 4-6 weekly review of lung function, medications, written asthma action plan, inhaler device technique, current asthma control and triggers; smoking cessation and vaccination advice. It is unknown if these key recommendations are provided to pregnant women with asthma in Australia. AIM To explore usual antenatal asthma management (usual care) in Australia and the inclusion of key recommendations. METHOD Pregnant women with asthma were invited to complete an online survey distributed in 2 antenatal clinics and via social media platforms from July 2017-Jan 2019. RESULTS The survey was completed by 142 pregnant women with asthma. 87(61%) were enrolled in an asthma management clinical trial and were therefore not receiving 'usual' care. Data presented is from 55(39%) women receiving usual care at survey completion. Of these women, 36% did not have their asthma reviewed during their pregnancy, 31% had a written asthma action plan, 11% had lung function assessed, 38% had an asthma medication review and 35% had their inhaler technique reviewed. 65% were not questioned about their asthma symptoms, 85% were not asked about asthma triggers, 96% were not given information about vaccinations and 95% did not receive smoking cessation information. CONCLUSIONS Overall, the key recommendations for antenatal asthma management were not always provided for this sample of pregnant women receiving usual care. Improved knowledge and implementation of these key recommendations by health professionals may alter this situation and improve maternal and infant outcomes.
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Affiliation(s)
- Karen McLaughlin
- School of Medicine and Public Health University of Newcastle, NSW, Australia; Priority Research Centre GrowUpWell, Hunter Medical Research Institute and University of Newcastle, NSW, Australia.
| | - Megan Jensen
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute and University of Newcastle, NSW, Australia
| | - Maralyn Foureur
- Hunter New England Local Health District, Nurses and Midwives Research Centre, University of Newcastle, Newcastle, NSW Australia
| | - Vanessa E Murphy
- School of Medicine and Public Health University of Newcastle, NSW, Australia; Priority Research Centre GrowUpWell, Hunter Medical Research Institute and University of Newcastle, NSW, Australia
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Williams C, Johnson B, Middleton PG, Backer V, Gibson PG, Hollis G, Coleman C. Family planning, pregnancy and birth in women with lung conditions: a worldwide survey. ERJ Open Res 2021; 7:00357-2021. [PMID: 34938801 PMCID: PMC8685512 DOI: 10.1183/23120541.00357-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022] Open
Abstract
Lung diseases can complicate pregnancy, but little is known about the experiences of pregnancy among women living with such diseases. This survey aimed to understand the experiences of women with a lung condition before and during pregnancy, in childbirth and post-partum. The survey was translated into nine languages and hosted online between March and May 2018. This paper reports on 327 women who had asthma, cystic fibrosis (CF), lymphangioleiomyomatosis (LAM) and sarcoidosis as a sole or primary lung condition. Women with CF and LAM were most likely to report that their condition influenced their decision to have children. Those with CF and LAM who did become pregnant reported greater satisfaction with their healthcare during pregnancy and gave more consideration to factors such as location and type of birth; they were also more concerned about the impact of the pregnancy on their health than women with other diseases. Women with sarcoidosis reported receiving conflicting advice as to both the impact of their condition on pregnancy and how becoming pregnant might impact their health. Women with asthma reported not always being able to access the information they needed from healthcare professionals. The results suggest that healthcare providers should be having dialogues with affected women early on, from before conception, throughout the pregnancy and after giving birth, and training should be provided to healthcare staff to equip them with the information they need to do this. This survey found that having a lung condition can play a significant role in women's decisions around family planning, pregnancy and birth. Women wanted more specialist support and better information before, during and after pregnancy.https://bit.ly/3CSpHt9
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Affiliation(s)
| | | | - Peter G Middleton
- CF Research Group, Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Vibeke Backer
- Department of ENT and CFAS, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Peter G Gibson
- Centre for Asthma and Respiratory Diseases, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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Stoup T, Chenivesse C. [Management of asthma during pregnancy]. Rev Mal Respir 2021; 38:626-637. [PMID: 34052060 DOI: 10.1016/j.rmr.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
Asthma is the most common chronic condition in pregnant women. The risks of complications associated with asthma for the mother, the foetus and the pregnancy are mainly due to uncontrolled asthma and the occurrence of exacerbations. These events are promoted by the patient's difficulty in complying with treatment or by prescription insufficiency for an unjustified fear of teratogenicity. The challenge of the management of asthma during pregnancy is to ensure optimal maternal asthma control in order to prevent foetal hypoxia and thus, reduce the risk of complications. Preventing the occurrence of asthma symptoms and exacerbations, ensuring optimal lung function and managing the risk factors of poor asthma outcomes and comorbidities are the principles necessary to achieve this goal. Because of the low or non-existent risks of the main treatments of asthma for the foetus and the mother, it is widely recommended that all therapies initiated before conception are continued, in particular inhaled corticosteroids, and to adjust the dosage to the minimum effective dose. During the preconception period and throughout pregnancy, coordination of the different healthcare professionals (general practitioner, respiratory specialist and gynecologist) is essential, with the mother-to-be playing a central role in the management of her asthma.
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Affiliation(s)
- T Stoup
- CHU Lille, université Lille, service de pneumologie et immuno-allergologie, centre de référence constitutif pour les maladies pulmonaires rares, 59000 Lille, France
| | - C Chenivesse
- CHU Lille, université Lille, CNRS, Inserm, institut Pasteur de Lille, service de pneumologie et immuno-allergologie, centre de référence constitutif pour les maladies pulmonaires rares, U1019, UMR 9017, Center for Infection and Immunity of Lille (CIIL), CRISALIS, F-CRIN Inserm network, 59000 Lille, France.
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Davies G, Jordan S, Thayer D, Tucker D, Humphreys I. Medicines prescribed for asthma, discontinuation and perinatal outcomes, including breastfeeding: A population cohort analysis. PLoS One 2020; 15:e0242489. [PMID: 33296383 PMCID: PMC7725302 DOI: 10.1371/journal.pone.0242489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To explore associations between exposures to medicines prescribed for asthma and their discontinuation in pregnancy and preterm birth [<37 or <32 weeks], SGA [<10th and <3rd centiles], and breastfeeding at 6-8 weeks. METHODS Design. A population-based cohort study. Setting. The Secure Anonymised Information Linkage [SAIL] databank in Wales, linking maternal primary care data with infant outcomes. Population. 107,573, 105,331, and 38,725 infants born 2000-2010 with information on premature birth, SGA and breastfeeding respectively, after exclusions. Exposures. maternal prescriptions for asthma medicines or their discontinuation in pregnancy. Methods. Odds ratios for adverse pregnancy outcomes were calculated for the exposed versus the unexposed population, adjusted for smoking, parity, age and socio-economic status. RESULTS Prescriptions for asthma, whether continued or discontinued during pregnancy, were associated with birth at<32 weeks' gestation, SGA <10th centile, and no breastfeeding (aOR 1.33 [1.10-1.61], 1.10 [1.03-1.18], 0.93 [0.87-1.01]). Discontinuation of asthma medicines in pregnancy was associated with birth at<37 weeks' and <32 weeks' gestation (aOR 1.22 [1.06-1.41], 1.53 [1.11-2.10]). All medicines examined, except ICS and SABA prescribed alone, were associated with SGA <10th centile. CONCLUSIONS Prescription of asthma medicines before or during pregnancy was associated with higher prevalence of adverse perinatal outcomes, particularly if prescriptions were discontinued during pregnancy. Women discontinuing medicines during pregnancy could be identified from prescription records. The impact of targeting close monitoring and breastfeeding support warrants exploration.
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Affiliation(s)
- Gareth Davies
- Faculty of Health and Life Science, Swansea University, Swansea, United Kingdom
| | - Sue Jordan
- Faculty of Health and Life Science, Swansea University, Swansea, United Kingdom
| | - Daniel Thayer
- Faculty of Health and Life Science, Swansea University, Swansea, United Kingdom
| | | | - Ioan Humphreys
- Faculty of Health and Life Science, Swansea University, Swansea, United Kingdom
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Robijn AL, Barker D, Gibson PG, Giles WB, Clifton VL, Mattes J, Peek MJ, Barrett HL, Seeho SK, Callaway LK, Abbott A, Attia J, Wark PA, Jensen ME, Murphy VE. Factors Associated with Nonadherence to Inhaled Corticosteroids for Asthma During Pregnancy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1242-1252.e1. [PMID: 33039640 DOI: 10.1016/j.jaip.2020.09.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/14/2020] [Accepted: 09/16/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nonadherence is common among pregnant women prescribed inhaled corticosteroids (ICS) for asthma and may have serious consequences for mother and baby. Factors associated with ICS nonadherence have not been determined in this population. OBJECTIVES To determine factors associated with {1} nonadherence to ICS in early-mid pregnancy (cross-sectional) and {2} persistent nonadherence to ICS during pregnancy (longitudinal). METHODS Data used come from 3 prospective studies (2004-2019) involving women with asthma recruited by 23 weeks' gestation (N = 1614). Demographics, asthma history, and current symptoms were assessed, and spirometry was performed at baseline and throughout pregnancy. Women self-reported current medication use and number of ICS doses missed in the past week. Nonadherence was defined as ≥20% of prescribed dosages missed in the past week (baseline) and on at least 2 occasions during follow-up (persistent). Factors associated with ICS nonadherence were examined using backward stepwise logistic regression. RESULTS Of 610 (38%) women prescribed ICS at baseline, 236 (39%) were classified as nonadherent. Of 612 (38%) women prescribed ICS during at least 2 follow-up visits, 149 (24%) were classified as persistent nonadherent. Factors associated with nonadherence at baseline were current or ex-smoking, non-Caucasian/non-Indigenous ethnicity, adult diagnosis of asthma, and lower lung function. Factors associated with persistent nonadherence to ICS were lower maternal age, higher parity, and no prescribed ICS at baseline. CONCLUSION Young multiparous non-Caucasian/non-Indigenous mothers are at increased risk of being nonadherent to ICS during pregnancy. Strategies to improve ICS nonadherence should address maternal smoking and target women who (re-)initiate ICS use in pregnancy.
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Affiliation(s)
- Annelies L Robijn
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Warwick B Giles
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Vicki L Clifton
- Mater Research Institute, University of Queensland, Translational Research Institute, South Brisbane, QLD, Australia
| | - Joerg Mattes
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Peadiatric Respiratory and Sleep Medicine Department, John Hunter Children's Hospital, New Lambton Heights, Newcastle, NSW, Australia
| | - Michael J Peek
- ANU Medical School, College of Health and Medicine, The Australian National University, Garran, ACT, Australia
| | - Helen L Barrett
- Chronic disease biology and care, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia; Department of Endocrinology, Mater Adult Hospital, Mater Health Services, Brisbane, QLD, Australia
| | - Sean K Seeho
- Department of Obstetrics and Gynaecology, Sydney Medical School Northern, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
| | - Leonie K Callaway
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Alistair Abbott
- Department of Respiratory and Sleep Medicine, Nepean Hospital, Kingswood, NSW, Australia; Nepean Clinical School, University of Sydney, Sydney, NSW, Australia
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Peter A Wark
- Priority Research Centre for Healthy Lungs, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Megan E Jensen
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Vanessa E Murphy
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
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Williamson GR, O'Connor A, Chamberlain C, Halpin D. mHealth resources for asthma and pregnancy care: Methodological issues and social media recruitment. A discussion paper. J Adv Nurs 2018; 74:2442-2449. [PMID: 29943472 DOI: 10.1111/jan.13773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/16/2018] [Accepted: 04/19/2018] [Indexed: 01/24/2023]
Abstract
AIMS A discussion of methodological issues and social media recruitment to a feasibility study to investigate mHealth resources for asthma and pregnancy care. BACKGROUND Pregnant women with asthma are reported to be poorly supported according to an international research. We sought to establish if a mHealth intervention might be feasible and acceptable to them. DESIGN A Phase I or modelling study. METHODS A project team designed an intervention to address UK national guidelines for the management of asthma during pregnancy, using other resources already accessible on the web. This was made available on a project website optimized for mobile phone usage. Links were Tweeted and advertised on Facebook, asking participants to access the project website, which included links to the resources and before- and after-use questionnaires to establish baseline symptom data and participant views of the resources. RESULTS Despite 55,700 Twitter impressions in a 76-day period over winter 2016-2017, this recruitment strategy garnered 402 engagements but only seven respondents for questionnaire 1 and zero respondents for questionnaire 2. CONCLUSIONS We could not recruit to this study despite believing that social media recruitment would be effective and we recommend that social media recruitment be used cautiously. Apparently, we did not sufficiently address the theoretical aspects of communications theory and were not clear enough about our key messages. Publication bias may exist about the non-publication of other failed telemedicine studies using social media; this goes largely unreported in some systematic reviews and may influence researchers' decision-making about social media recruitment.
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Affiliation(s)
- Graham R Williamson
- Adult Nursing, The Exeter School of Nursing, University of Plymouth, WESC Foundation, Topsham Rd, Exeter, UK
| | - Anita O'Connor
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth, Devon, UK
| | | | - David Halpin
- Royal Devon and Exeter Hospital NHS Foundation Trust, Barrack Rd, Exeter, UK
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Williamson GR, O’Connor A, Kayleigh EJ. Women's experiences of personalised support for asthma care during pregnancy: A systematic review of the literature. BMC Pregnancy Childbirth 2017; 17:69. [PMID: 28219350 PMCID: PMC5319072 DOI: 10.1186/s12884-017-1241-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/31/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Asthma and pregnancy are both sources of anxiety for women. Although there has been a focus on physiological management of asthma and pregnancy, there has been little research on the impact that personalised support can have on asthma care during pregnancy. This systematic review and narrative synthesis of the literature set out to answer the question 'What are women's experiences of asthma care, its management and education, during pregnancy?' METHODS This systematic review was carried out using accepted methodology from the York Centre for Reviews and Dissemination. Electronic database searches were conducted using PsycInfo, CINAHL, MedLine, Google Scholar and the Cochrane Library, using the combination search terms: 'Asthma' AND 'Pregnancy' AND 'Care' AND ('Education OR Information OR Experience'). Hand searching of journals and searches for grey literature were also undertaken. Independent quality appraisal by the three authors took place using the criteria detailed by Kmet et al. (Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields, 2004). RESULTS All papers scoring in excess of 60% were deemed to be of adequate quality for inclusion, of which there were five: two qualitative designs and three quantitative designs. The designs were too methodologically heterogeneous to permit statistical meta-analysis so narrative review and synthesis was undertaken. Despite an embryonic evidence bases, it is reasonable to conclude that personalised care has beneficial outcomes for pregnant asthmatic women. CONCLUSIONS Larger randomised controlled trials investigating personalised care are required to build an evidence base which can establish the efficacy of such interventions.
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Affiliation(s)
- Graham R. Williamson
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth, Devon PL48AA UK
| | - Anita O’Connor
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth, Devon PL48AA UK
| | - Elmslie-Jones Kayleigh
- Women’s Health Directorate, Royal Devon and Exeter Hospital NHS Trust, Barrack RD., Exeter, EX25DW UK
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Abstract
Asthma is a common comorbidity during pregnancy and its prevalence is increasing in the community. Exacerbations are a major clinical problem during pregnancy with up to 45% of women needing to seek medical help, resulting in poor outcomes for mothers and their babies, including low birth weight and preterm delivery. The goals of effective asthma management in pregnancy are to maintain the best possible asthma control and prevent exacerbations. This is achieved by aiming to prevent day- and night-time symptoms, and maintain lung function and normal activity. In addition, maintaining fetal oxygenation is an important consideration in pregnancy. Guidelines recommend providing asthma advice and review prior to conception, and managing asthma actively during pregnancy, with regular 4-weekly review, provision of a written action plan, use of preventer medications as indicated for other adults with asthma, and management of comorbid conditions such as rhinitis. Improvements have been made in recent years in emergency department management of asthma in pregnancy, and multidisciplinary approaches are being proposed to optimise both asthma outcomes and perinatal outcomes. One strategy that has demonstrated success in reducing exacerbations in pregnancy is treatment adjustment using a marker of eosinophilic lung inflammation, the exhaled nitric oxide fraction (F eNO). The use of an algorithm that adjusted inhaled corticosteroids (ICS) according to F eNO and added long-acting β-agonists when symptoms remained uncontrolled resulted in fewer exacerbations, more women on ICS but at lower mean doses, and improved infant respiratory health at 12 months of age. Further evidence is needed to determine whether this strategy can also improve perinatal outcomes and be successfully translated into clinical practice. KEY POINTS Asthma is the most common chronic disease to affect pregnant women.Exacerbations occur in up to 45% of pregnant women with asthma.Asthma should be managed during pregnancy as for other adults.Treatment adjustment using a marker of airway inflammation reduces the exacerbation rate in pregnancy. EDUCATIONAL AIMS To identify the goals of and steps associated with effective asthma management in pregnancy.To understand the maternal and perinatal risks associated with asthma during pregnancy.To describe a management strategy that has been shown to reduce exacerbations in pregnant women with asthma.
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Affiliation(s)
- Vanessa E. Murphy
- Centre for Asthma and Respiratory Disease, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
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