Control and drug attitude during the first trimester of pregnancy in asthmatic women

According to best practice guidelines asthmatic women during pregnancy must continue with their asthmatic medication. The purpose of this study was to assess control and drug attitude when an asthmatic women gets pregnant. This was a multicentre, prospective study of asthmatic women that were followed during their first trimester of pregnancy who attend a pulmonologist or allergy office. Classification of asthma severity was determined upon enrollment in the study. Measurement of nitric oxide (FENO), spirometry and Asthma Control test (ACT) were performed. Also taking into account a home peak-flow registry during the 14 previous days. Pharmacological management was tailored based of investigators criteria. Results: 141 patients were enrolled (20% intermittent, 27% mild, 50% moderate and 5% severe asthma). Mean ACT score of 19±4, FEV1 77±8%, FENO 46±12 ppb and morning peak-flow 404±90. Only 49% achieved full asthma control. At study entry women were treated daily with the following medication: 40% inhaled corticosteroids, 28% LABA, 27% leukotriene receptor antagonists (LTRAs) and 42% salbutamol. At baseline, treatment was modify in 55% of patients( 76% inhaled corticosteroids, 35% LABA and 35% LTRAs.) Baseline mean dose of budesonide 182±29mg vs final 408±4mg. ACT score correlated (Spearman) with morning peak-flow (R:0.314; p=0.013); FEV1/FCV (R: -0.228; p=0.011); previous asthma severity(R:-0.358; p=0.0001); FENO(R:-0.299; p=0.005) and salbutamol use (R:-0.548; P=0.0001) Conclusion: Our findings show that more than half of pregnant women loses their asthma control during the first trimester. Specialists should review all pregnant asthmatics. This study was funded by FNV 2009 and Pfizer SLU.