[Asthma and pregnancy. Review of the current literature and management according to the GINA 2006-2007 guidelines]

Prescription of asthma medications before and during pregnancy in France: An observational drug study using the EFEMERIS database

OBJECTIVE

Asthma affects between 3% to 8% of pregnant women. Previous studies have suggested that women's prescriptions for asthma medications change during pregnancy. The aim was to describe the prescription of asthma medications before and during pregnancy in France.

METHODS

Women from the EFEMERIS, a French database assessing the drugs prescribed, dispensed and reimbursed during pregnancy, delivering between July 2004 and December 2012, were included. Women, who were dispensed asthma medications on at least two dates from 3 months prior to pregnancy through delivery, were considered.

RESULTS

2,977 women out of 69,205 (4%) were selected. They were prescribed 2.4 ± 1.2 different anti-asthmatic drugs with 3.5 ± 2.7 different dispensing dates. Almost 62% of the women were dispensed at least one prescription for short-acting β2-agonist (SABA), 63% at least one inhaled corticosteroid (IC), 42% a fixed-combination of an IC and a long-acting β2-agonist (LABA) and 8% a LABA. An increase in SABA and IC prescriptions and a decrease in fixed-combination prescriptions were observed during pregnancy compared to pre-pregnancy period. A rapid drop in prescriptions for montelukast was observed. Among the 1,507 women who were prescribed asthma medication before pregnancy, one third had a drop in dispensed asthma medications from the beginning of pregnancy.

CONCLUSIONS

The prevalence of dispensed asthma medications varies during pregnancy. There is a decrease in the prescriptions of fixed-combinations during pregnancy and an increase in the prescriptions of ICs. It appears important to study the potential impact of such changes on fetuses and newborns.

Enrolment in an Asthma Management Program during Pregnancy and Adherence with Inhaled Corticosteroids: The 'Management of Asthma during Pregnancy' Program

BACKGROUND

Poor adherence with inhaled corticosteroids (ICS) is a major problem in asthma and according to previous studies not least during pregnancy.

OBJECTIVE

Our aim was to assess if enrolment in an asthma management program, and by that close monitoring, can improve self-reported and documented adherence with ICS in pregnant women with asthma.

METHODS

Pregnant women with doctor-diagnosed asthma, currently being prescribed ICS, referred during a 12-month period to the outpatient respiratory clinic, were consecutively included in the study. They had follow-up visits every 4 weeks during pregnancy. Asthma control was assessed according to GINA guidelines. Self-reported adherence was compared to documented adherence, defined as medical possession rate (MPR), calculated on the basis of filled prescriptions (data from each individuals' medication profile at www.fmk-online.dk).

RESULTS

A total of 130 women fulfilled the inclusion criteria, but at the initial visit, 16 women reported no current use of ICS, and the analyses are therefore based on 114 patients. Self-reported adherence to ICS was significantly higher during pregnancy than before pregnancy (73 and 52%, respectively, reporting good adherence; p < 0.001). The actual adherence, i.e. MPR, was also higher during pregnancy than before (46 vs. 28%, p < 0.0001). In keeping with this, an overall improvement was also observed in asthma control. Of the women with a low pre-pregnancy MPR, 71% had moderate or good adherence (MPR) during pregnancy. Self-reported adherence was significantly correlated with MPR during pregnancy (p = 0.004) but not before pregnancy (p = 0.46). At the 3-month postpartum visit, adherence was close to the pre-pregnancy level.

CONCLUSION

Enrolment in an asthma management program during pregnancy seems to improve adherence with controller medication, but self-reported adherence is not a valid measure for actual adherence in patients with asthma.

[Features of asthma in women: what is the relationship with hormonal status?]

INTRODUCTION

The prevalence and control of asthma are modulated by hormonal changes in women, suggesting an influence of sex hormones on the airways.

BACKGROUND

The blood levels of both oestrogens and progesterone can modulate airway tone and inflammation. Asthma prevalence changes at puberty and the menopause, events also associated with modifications of adipose tissue and behaviour. Changes in lung function and asthma control are well documented during the menstrual cycle. However, an effect of hormone therapy on asthma control has not been demonstrated.

PERSPECTIVE

The effect of a targeted hormonal therapeutic intervention in menopausal asthma, a phenotype, which is frequently particularly severe, or in premenstrual asthma, should be evaluated by randomized trials.

CONCLUSION

Involvement of sex hormones and their cyclical variations in the characteristics of asthma in women is probable, despite lack of convincing data. However, no definitive protective or deleterious effect can be assigned. Complex interactions with adipose tissue, airways anatomy and the domestic or working environment must be taken into account to explain these differences.

[Exacerbations of asthma in pregnant women]

Prevention of exacerbations and effective treatment is essential in pregnant asthmatic women. The management is well documented. Misunderstanding of the recommendations leads to unsuitable, insufficient treatment and is responsible for more frequent recurrences in the pregnant woman compared with the non pregnant. Above all, good control of the disease and the prevention of exacerbations, based on inhaled corticosteroid therapy and smoking cessation, reduces complications, in particular prematurity and low birth weight.