Poorly controlled asthma common in pregnancy
The prevalence of poor asthma control during pregnancy is high among women in the United States, especially among the Medicaid population, and dispensing of long-term controller medication is low, new data suggest.
In a recent study, Jacqueline M. Cohen, PhD, from the department of epidemiology at the Harvard T.H. Chan School of Public Health in Boston, Michael Schatz, MD, MS, FAAAAI, from the department of allergy at Kaiser Permanente Medical Center in San Diego and principal investigator for the Vaccines and Medications in Pregnancy Surveillance System (VAMPSS), and colleagues evaluated the prevalence, severity and control of asthma in two cohorts of pregnancies that ended in live births using data from two large U.S. health care claims databases: Truven Health MarketScan Commercial Claims and Encounters Database (MarketScan) for 2011 to 2015 and the Medicaid Analytic eXtract (MAX) from 2000 to 2013.
In the MarketScan cohort, 3.3% of women had asthma and 19% had severe asthma. Similarly, in the MAX cohort, 5.8% had asthma and 18.8% had severe asthma. The proportion of women with poorly controlled asthma, however, was greater in those with public insurance (MAX) than in those with private insurance (MarketScan; 28% vs. 16.5%).
In both cohorts, poor asthma control was associated with smoking, obesity, chronic conditions, such as diabetes, and non-asthma medications, including opioids. Women with poor asthma control also had more outpatient visits, ED visits and hospitalizations. In MAX, poor asthma control was also more likely in older women.
Most women received at least one dispensing for a short-acting beta agonist in the MarketScan (69%) and MAX (80%) cohorts, with lower proportions receiving other medications such as inhaled corticosteroids, inhaled corticosteroids/long-acting beta agonists and rescue low-dose oral corticosteroids, during pre-pregnancy and pregnancy. However, prescription patterns overall were scattered, the researchers noted, and few women consistently filled prescriptions in all trimesters.
Although poor asthma control was linked to severe asthma, 38.4% of women in MarketScan and 43.3% in MAX with poorly controlled asthma did not fill a prescription for long-acting control medication during pregnancy. Prepregnancy asthma severity proved to be a poor predictor for asthma control during pregnancy and the proportion of women with at least one exacerbation during pregnancy was comparable to that for women with mild asthma at baseline vs. severe asthma at baseline.
“Adhering to recommended asthma treatments is extremely important, and what we’re seeing is that many pregnant women with poorly controlled asthma aren’t filling prescriptions for long-term asthma care. Getting asthma symptoms under control could improve health outcomes for both the mothers and their children,” Cohen said in a press release.
“While it’s understandable that mothers are concerned about the safety of their children and the effect medications may have during pregnancy, current asthma guidelines recommend that women continue their asthma treatment plan throughout the entire pregnancy because the risks of uncontrolled asthma appear to be greater than the risk of recommended asthma medications,” Schatz said in the release. “There is an urgent need to provide additional evidence on the risks and benefits of asthma medications during pregnancy to improve asthma control and reduce anxiety regarding medication safety in our patients. Our hope is that the information gleaned through VAMPSS will contribute to more complete risk and safety information on pharmaceutical labels for pregnant and lactating women.” – by Melissa Foster
Disclosures: The project was funded by GlaxoSmithKline as part of the VAMPSS collaboration. Schatz reports he consulted for GlaxoSmithKline and he received industry-sponsored research grants to his institution from AstraZeneca Medimmune, GlaxoSmithKline and Merck and he consulted for GlaxoSmithKline. Cohen reports no relevant financial disclosures. Please see the study for all other authors’ financial disclosures.