Subspecialty intervention can improve asthma outcomes among inner-city pregnant women
Published: May 22, 2021
Asthma exacerbations are common during pregnancy and have the potential to contribute to poor outcomes for mothers and their babies. Self-management education can be effective in reducing the unpredictable variability of asthma control in this population. However, there is little known about the influence of such an integrated asthma intervention on urban, minority pregnant women, who have unique exposures and socioeconomic limitations impacting their care.
In their prospective interventional study published in The Journal of Allergy and Clinical Immunology in Practice, Yoo et al. designed and implemented a prenatal asthma clinic integrated into routine obstetric care to provide education, regular monitoring, and focused follow-up for pregnant women in inner-city Philadelphia. At the time of enrollment, pulmonary physicians provided extensive asthma education and, if necessary, modified inhaler regimens to optimize asthma control. Baseline measurements included the Asthma Control Test (ACT) and self-administered Asthma Quality of Life Questionnaire (MiniAQLQ). For those who returned for follow-up, patient-reported outcome scores were collected in order to assess for improved symptom control after initial visit.
Among 85 predominantly minority women enrolled, 34-43% had a history of requiring systemic corticosteroids in the year preceding, and 72 (84.7%) were clinically found to have inadequate asthma control resulting in an increase in their maintenance therapy at their initial visit. Fifty-three (62.4%) women attended at least one follow-up visit, and of those, 32.1% required further step-up therapy. There was a significant increase in ACT scores between initial visit and first follow-up visit, and for those with follow-up MiniAQLQ data, there was also significant improvement.
These results demonstrate that in this vulnerable population, an integrated prenatal asthma intervention comprised of assessment, education and surveillance, can improve asthma symptoms and control as indicated by patient-reported outcome measures. Identification of barriers to asthma care continuity and efforts to optimize accessibility may further improve the quality of asthma care in this understudied population of inner-city women during pregnancy.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.