Trends in asthma self-management skills and inhaled corticosteroid use during pregnancy and postpartum from 2004 to 2017

ABSTRACT

Objective: Asthma exacerbations and medication non-adherence are significant clinical problems during pregnancy. While asthma self-management education is effective, the number of education sessions required to maximise asthma management knowledge and inhaler technique and whether improvements persist postpartum, are unknown. This paper describes how asthma knowledge, skills, and inhaled corticosteroid (ICS) use have changed over time. Methods: Data were obtained from 3 cohorts of pregnant women with asthma recruited in Newcastle, Australia between 2004 and 2017 (N = 895). Medication use, adherence, knowledge, and inhaler technique were compared between cohorts. Changes in self-management knowledge/skills and women's perception of medication risk to the fetus were assessed in 685 women with 5 assessments during pregnancy, and 95 women who had a postpartum assessment. Results: At study entry, 41%, 29%, and 38% of participants used ICS in the 2004, 2007, and 2013 cohorts, respectively (p = 0.017), with 40% non-adherence in each cohort. Self-management skills of pregnant women with asthma did not improve between 2004 and 2017 and possession of a written action plan remained low. Maximum improvements were reached by 3 sessions for medications knowledge and one session for inhaler technique, and were maintained postpartum. ICS adherence was maximally improved after one session, but not maintained postpartum. Perceived risk of asthma medications on the fetus was highest for corticosteroid-containing medication; and was significantly reduced following education. Conclusions: There was a high prevalence of non-adherence and poor self-management skills in all cohorts. More awareness of the importance of optimal asthma management during pregnancy is warranted, since no improvements were observed over the past decade.

KEYWORDS:

• Inhaler device technique
• Knowledge
• Non-adherence
• Perceived risk

Acknowledgement

The authors would like to thank the staff of the antenatal clinics at the John Hunter Hospital (Newcastle) for assistance with patient recruitment and clinical assessment. Specifically, we thank Kelly Steel, Karen McLaughlin, and Philippa Talbot. We also thank all women who participated in one or more studies.

Funding

Project funding was received from Hunter Medical Research Institute, Port Waratah Coal Services, University of Newcastle, Asthma Foundation of NSW, National Health and Medical Research Council, the Singleton Foundation, John Hunter Hospital Charitable Trust, University of Newcastle Priority Research Centre GrowUpWell^TM and the Woodend Foundation.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

HLB is supported by an NHMRC Early Career Research Fellowship (APP1120070). PGG received a Practitioner Fellowship from the NHMRC. VEM received an Australian Research Training Fellowship (part-time, grant ID 455626, 2007–2012) and a Career Development Fellowship from the NHMRC (grant ID 1084816, since 2015).