Schatz Michael, Leibman Christopher
Kaiser-Permanente Medical Center, San Diego, California, USA.
Ann Allergy Asthma Immunol. 2005 Sep;95(3):234-8. doi: 10.1016/S1081-1206(10)61219-7.
Current asthma management guidelines recommend aggressive asthma treatment for women who are pregnant.
To examine asthma medication use and asthma-related health care use before and during pregnancy.
Women aged 15 to 45 years with a pregnancy claim (index event) and an asthma claim (diagnosis or asthma medication prescription) were identified from a database of US managed care organizations (PharMetrics Patient-Centric Database). Medical claims 6 months before and after the index event were studied to determine the impact of pregnancy on asthma medication use (ie, prescription claims) and asthma-related physician visits, emergency department (ED) visits, and hospitalizations.
Of 7,235 women with a pregnancy claim and 6 months of preindex and postindex data, 633 had an asthma claim (334 had an asthma-related medication claim and 299 had no asthma-related medication claim before the index event). During the preindex period, 142 patients were using asthma controller medications, with inhaled corticosteroids (ICSs) the most commonly used controller (n = 101); 283 were using short-acting beta2-adrenergic agonists (SABAs) with or without controllers. Among the 334 patients using asthma medication before pregnancy, the number using any controller decreased from 142 to 94 (-34%), those using ICSs decreased from 101 to 65 (-36%), and those using SABAs decreased from 283 to 137 (-52%) after the pregnancy claim. For these 334 patients, the number with an asthma-related ED visit increased from 14 to 17 (21%) after the pregnancy claim. Among those without a pharmacy record of medication use before pregnancy (n = 299), the number with an asthma-related ED visit increased from 4 to 7 (75%) after the pregnancy claim. For the 101 patients using ICSs before pregnancy, the number with an asthma-related physician visit decreased from 39 to 25 (-36%) and the number with an ED visit was unchanged. For the 532 patients not using an ICS before pregnancy, the number with an asthma-related physician visit increased from 84 to 107 (27%) and the number with an ED visit increased from 12 to 18 (50%).
For patients using an ICS before pregnancy, the rate of asthma-related physician visits decreased and the number of ED visits was unchanged after pregnancy, whereas physician and ED visits increased after pregnancy for patients not using an ICS before pregnancy. Overall, the data suggest that asthma is undertreated in women contemplating pregnancy and in those who are pregnant.
当前哮喘管理指南建议对怀孕女性进行积极的哮喘治疗。
研究怀孕前及孕期哮喘药物的使用情况以及与哮喘相关的医疗保健利用情况。
从美国管理式医疗组织数据库（PharMetrics以患者为中心的数据库）中识别出年龄在15至45岁之间、有妊娠记录（索引事件）且有哮喘记录（诊断或哮喘药物处方）的女性。对索引事件前后6个月的医疗记录进行研究，以确定妊娠对哮喘药物使用（即处方记录）以及与哮喘相关的医生就诊、急诊科就诊和住院情况的影响。
在7235名有妊娠记录且有索引事件前后6个月数据的女性中，633人有哮喘记录（334人在索引事件前有与哮喘相关的药物记录，299人在索引事件前没有与哮喘相关的药物记录）。在索引事件前的时期，142名患者使用哮喘控制药物，其中吸入性糖皮质激素（ICS）是最常用的控制药物（n = 101）；283人使用短效β2肾上腺素能激动剂（SABA），无论是否使用控制药物。在妊娠记录前使用哮喘药物的334名患者中，使用任何控制药物的人数从142人降至94人（-34%），使用ICS的人数从101人降至65人（-36%），使用SABA的人数从283人降至137人（-52%）。对于这334名患者，妊娠记录后与哮喘相关的急诊科就诊人数从14人增至17人（21%）。在妊娠记录前没有药房用药记录的患者（n = 299）中，妊娠记录后与哮喘相关的急诊科就诊人数从4人增至7人（75%）。对于妊娠记录前使用ICS的101名患者，与哮喘相关的医生就诊人数从39人降至25人（-36%），急诊科就诊人数未变。对于妊娠记录前未使用ICS的532名患者，与哮喘相关的医生就诊人数从84人增至107人（27%），急诊科就诊人数从12人增至18人（50%）。
对于妊娠记录前使用ICS的患者，妊娠后与哮喘相关的医生就诊率下降，急诊科就诊人数未变，而妊娠记录前未使用ICS的患者妊娠后医生就诊和急诊科就诊人数增加。总体而言，数据表明在计划怀孕的女性和已怀孕的女性中，哮喘治疗不足。
