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Targeting inhaled corticosteroid non-adherence during pregnancy

Published online: October 8, 2020

Asthma is one of the most common conditions to affect pregnancy, with a prevalence of up to 13% worldwide. The use of asthma medications, such as inhaled corticosteroids (ICS), helps to control symptoms and reduces the risk of exacerbations. However, non-adherence to ICS is a significant clinical problem, with rates as high as 40% of women with asthma. ICS non-adherence has been associated with 29% of asthma exacerbations during pregnancy. Improving ICS non-adherence during pregnancy is therefore of clinical importance.

A study by Robijn et al., recently published in The Journal of Allergy and Clinical Immunology: In Practice, aimed to identify factors associated with ICS non-adherence in early-mid pregnancy as well as persistent non-adherence during pregnancy. The authors utilized data from 3 Australian clinical trials conducted between 2004 and 2019. The investigators based non-adherence on the self-reported number of dosages missed in the past week. Women in the study were classified as being persistent non-adherent if they were non-adherent at least twice during the follow-up of the study.

The authors found that current smokers were twice, and ex-smokers 1.7 times, as likely to be non-adherent in early-mid pregnancy compared to never smokers. Women identifying as non-Caucasian/non-Indigenous were twice as likely to be non-adherent compared to women identifying as Caucasian. Furthermore, having received an asthma diagnosis as an adult and reduced lung function were associated with increased odds of ICS non-adherence. Factors associated with increased odds of persistent non-adherence are younger age, increased parity and not using ICS medication at study entry at 18 week’s gestation.

The factors associated with ICS non-adherence during pregnancy identified by Robijn and colleagues may help healthcare professionals to identify women who are at risk of ICS non-adherence during pregnancy and thereby implement early interventions to address medication adherence.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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