Asthma morbidity during pregnancy can be predicted by severity classification

doi:10.1067/mai.2003.1516

Journal of Allergy and Clinical Immunology

Volume 112, Issue 2, August 2003, Pages 283-288

Presented at the 56th Annual Meeting of the American Academy of Allergy, Asthma and Immunology, San Diego, Calif, April 2000.

https://doi.org/10.1067/mai.2003.1516 Get rights and content

Abstract

Background: The 1993 National Asthma Education Program Working Group on Asthma and Pregnancy defined asthma severity as mild, moderate, or severe on the basis of symptoms and spirometry, but no studies have evaluated the relationship between this classification system and subsequent asthma morbidity during pregnancy. Objective: The objective of this study was to evaluate the relationship between asthma severity classification during pregnancy and gestational asthma exacerbations. Methods: Asthma severity was defined according to the 1993 classification, adjusted to include medication requirements, in a volunteer sample of 1739 pregnant asthmatic patients who were less than 26 weeks' gestation. Results: Initial asthma classification (mild, moderate, or severe) was significantly related to subsequent asthma morbidity during pregnancy (hospitalizations, unscheduled visits, corticosteroid requirements, and asthma symptoms during labor and delivery). Exacerbations during pregnancy occurred in 12.6% of patients initially classified as mild, 25.7% of patients classified as moderate, and 51.9% of patients classified as severe (P < .001). Asthma morbidity was similar, whether patients were classified as moderate or severe by symptoms and spirometry or by medication requirement. Thirty percent of initially mild patients were reclassified as moderate-severe during pregnancy, and 23% of the initially moderate-severe patients were reclassified as mild later in pregnancy; asthma morbidity in these patients changed accordingly. Conclusion: The National Asthma Education Program Working Group on Asthma and Pregnancy classification of asthma severity, adapted to include medication use, predicts subsequent asthma morbidity during pregnancy. (J Allergy Clin Immunol 2003;112:283-8.)

Section snippets

Methods

A prospective observational cohort study was conducted at 16 centers of the Maternal Fetal Medicine Units network during a period of 4 years with a target enrollment of 900 subjects with mild asthma and 900 subjects with moderate-severe asthma. Participants with mild asthma were matched for smoking status (any in the past week) with the non-mild cohort. Recruitment began in December 1994 and ended in March 1999. Case finding was by questioning all obstetric patients about having

Results

Between December 1994 and June 2000, 2562 pregnant asthmatic patients met the inclusion criteria for the study at the participating centers. Of these, 359 refused to participate, and 391 were not asked to participate (98 because they were outside the center's quota, 293 for uncertain reasons). The final enrolled cohort included 1812 patients, of whom 73 (4.0%) were lost to follow-up. Of the remaining 1739, asthma was classified as mild in 873 (50.2%), moderate in 814 (46.8%), and severe in 52

Discussion

In 1993, the NAEPP Working Group on Asthma and Pregnancy¹ used the 1991 NAEPP Expert Panel Guidelines³ to recommend a severity classification for asthma during pregnancy based on symptom frequency and pulmonary function.¹ However, no prior study has evaluated the relationship between this severity classification and subsequent asthma morbidity during pregnancy. Our data clearly demonstrate that the risk of asthma exacerbation during pregnancy is a function of asthma severity, as defined by a

Acknowledgements

We would like to acknowledge the support of James Kiley, National Heart, Lung, and Blood Institute.

References (10)

DJ Gottlieb et al.
Poverty, race, and medication use are correlates of asthma hospitalization rates
Chest
(1995)
National Asthma Education Program
Report of the Working Group on Asthma and Pregnancy. Management of asthma during pregnancy
(1993)
National Asthma Education and Prevention Program Expert Panel Report 2
Guidelines for the diagnosis and management of asthma
(1997)
National Asthma Education Program Expert Panel Report
Guidelines for the diagnosis and management of asthma
(1991)
R Liard et al.
Using Global Initiative for Asthma guidelines to assess asthma severity in populations
Eur Respir J
(2000)

There are more references available in the full text version of this article.

Cited by (232)

The influence of asthma on neuroinflammation and neurodevelopment: From epidemiology to basic models
2024, Brain, Behavior, and Immunity
Asthma is a highly heterogeneous inflammatory disease that can have a significant effect on both the respiratory system and central nervous system. Population based studies and animal models have found asthma to be comorbid with a number of neurological conditions, including depression, anxiety, and neurodevelopmental disorders. In addition, maternal asthma during pregnancy has been associated with neurodevelopmental disorders in the offspring, such as autism spectrum disorders and attention deficit hyperactivity disorder. In this article, we review the most current epidemiological studies of asthma that identify links to neurological conditions, both as it relates to individuals that suffer from asthma and the impacts asthma during pregnancy may have on offspring neurodevelopment. We also discuss the relevant animal models investigating these links, address the gaps in knowledge, and explore the potential future directions in this field.
Managing Asthma During Pregnancy and the Postpartum Period
2023, Journal of Allergy and Clinical Immunology: In Practice
Asthma is one of the most common chronic diseases in pregnancy and is associated with adverse perinatal outcomes. Asthma symptoms worsen in approximately 40% of women, and exacerbations requiring medical intervention occur in at least 20% of women. Factors associated with exacerbation and worsening asthma include multiparity, obesity, Black race, exacerbations before pregnancy, and poor asthma control. Exacerbations are associated with further increased risks for poor perinatal outcomes, including low birth weight, preterm birth, and small for gestational age (SGA) status, as well as an increase in the development of asthma in early childhood. Common medications used for asthma, including short-acting β-agonists and inhaled corticosteroids, are considered safe to use in pregnancy. Whereas guidelines generally suggest traditional step therapy for managing asthma in pregnancy, there are alternative models of care and management approaches that may be effective in pregnancy, but require more research. These include single-inhaler maintenance and reliever therapy, treatment adjustment with FeNO, treatable traits personalized medicine approaches, and telemedicine. Little is known about changes to asthma in the postpartum period. However, low adherence to medication and the potential effects of postpartum depression on asthma exacerbation risk warrant further research.
Longitudinal Changes in Upper and Lower Airway Function in Pregnancy
2023, Immunology and Allergy Clinics of North America
Status Asthmaticus Gravidus: Emergency and Critical Care Management of Acute Severe Asthma During Pregnancy
2023, Immunology and Allergy Clinics of North America
Are pregnant women with asthma receiving guideline-recommended antenatal asthma management? A survey of pregnant women receiving usual care in Australia
2023, Women and Birth
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.
To explore usual antenatal asthma management (usual care) in Australia and the inclusion of key recommendations.
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.
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.
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.
Asthma in pregnancy – Management, maternal co-morbidities, and long-term health
2022, Best Practice and Research: Clinical Obstetrics and Gynaecology
Citation Excerpt :
A recent study using an unsupervised machine learning approach found only two trajectories which described changes in asthma symptoms during pregnancy in 308 women: worsening asthma, experienced by 40% of the cohort, and no change in asthma symptoms, experienced by 60% of the cohort [7]. Exacerbations of asthma are common and require medical intervention for between 20% [8] and 45% of women [9]. Viral infections commonly precipitate exacerbations of asthma in pregnancy [10], as in children and adults with asthma.
Asthma is the most prevalent chronic disease in pregnancy, and as symptoms can change with pregnancy, and exacerbations of asthma are common, regular review of asthma symptoms, the provision of self-management education, and appropriate medication use are the hallmarks of management. Co-morbidities are also prevalent among pregnant women with asthma, with obesity, gestational diabetes, hypertension, rhinitis, depression, and anxiety, more common among women with asthma than women without asthma. Less is known about reflux, obstructive sleep apnoea and vocal cord dysfunction, along with nutritional deficiencies to iron and vitamin D. Maternal asthma impacts the offspring's long-term health, particularly in increasing the risk of early life wheeze and asthma in childhood. While breastfeeding may modify the risk of infant wheeze, less is known about the mechanisms involved. More research is needed to further understand the relationship between asthma in pregnancy and the risk of poor neurodevelopmental outcomes, such as autism.

View all citing articles on Scopus

^☆: Supported by grants from the National Institute of Child Health and Human Development (HD21410, HD21414, HD21434, HD27869, HD27917, HD27905, HD27889, HD27860, HD27861, HD27915, HD27883, HD34122, HD34116, HD34208, HD34136, HD19897) and the National Heart, Lung, and Blood Institute

^☆☆: *Participants in the Network of Maternal-Fetal Medicine Units are listed in Appendix 1.

^★: Reprint requests: Michael Schatz, MD, MS, Chief, Department of Allergy, Kaiser-Permanente Medical Center, 7060 Clairemont Mesa Blvd, San Diego, CA 92111.

View full text

Asthma, Rhinitis, other Respiratory DiseasesAsthma morbidity during pregnancy can be predicted by severity classification☆,☆☆,★

Abstract

Section snippets

Methods

Results

Discussion

Acknowledgements

Chest

Report of the Working Group on Asthma and Pregnancy. Management of asthma during pregnancy

Guidelines for the diagnosis and management of asthma

Guidelines for the diagnosis and management of asthma

Using Global Initiative for Asthma guidelines to assess asthma severity in populations

Eur Respir J

Asthma, Rhinitis, other Respiratory Diseases
Asthma morbidity during pregnancy can be predicted by severity classification☆,☆☆,★