Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville.
Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Hospital, Melbourne.
Chest. 2014 May;145(5):1046-1054. doi: 10.1378/chest.13-2276.
Uncontrolled asthma during pregnancy is associated with maternal and perinatal hazards. A pharmacist-led intervention directed at improving maternal asthma control, involving multidisciplinary care, education, and regular monitoring to help reduce these risks, was developed and evaluated.
A randomized controlled trial was carried out in the antenatal clinics of two major Australian maternity hospitals. Sixty pregnant women < 20 weeks gestation who had used asthma medications in the previous year were recruited. Participants were randomized to either an intervention or a usual care group and followed prospectively throughout pregnancy. The primary outcome was Asthma Control Questionnaire (ACQ) score. Mean changes in ACQ scores from baseline were compared between groups at 3 and 6 months to evaluate intervention efficacy.
The ACQ score in the intervention group (n = 29) decreased by a mean ± SD of 0.46 ± 1.05 at 3 months and 0.89 ± 0.98 at 6 months. The control group (n = 29) had a mean decrease of 0.15 ± 0.63 at 3 months and 0.18 ± 0.73 at 6 months. The difference between groups, adjusting for baseline, was -0.22 (95% CI, -0.54 to 0.10) at 3 months and -0.60 (95% CI, -0.85 to -0.36) at 6 months. The difference at 6 months was statistically significant (P < .001) and clinically significant (> 0.5). No asthma-related oral corticosteroid use, hospital admissions, emergency visits, or days off from work were reported during the trial.
A multidisciplinary model of care for asthma management involving education and regular monitoring could potentially improve maternal asthma outcomes and be widely implemented in clinical practice.
Australian and New Zealand Clinical Trials Registry; No.: ACTRN12612000681853; URL: www.anzctr.org.au.
孕期哮喘失控与母婴围产期风险相关。本研究开发并评估了一种药师主导的干预措施，该措施旨在通过多学科护理、教育和定期监测来改善产妇哮喘控制，以帮助降低这些风险。
在澳大利亚两家主要妇产医院的产前门诊进行了一项随机对照试验。招募了 60 名妊娠不足 20 周且在过去一年中使用过哮喘药物的孕妇。参与者被随机分配到干预组或常规护理组，并在整个孕期进行前瞻性随访。主要结局是哮喘控制问卷（ACQ）评分。比较两组患者在 3 个月和 6 个月时的基线 ACQ 评分变化，以评估干预效果。
干预组（n=29）的 ACQ 评分在 3 个月时平均下降 0.46±1.05，在 6 个月时平均下降 0.89±0.98。对照组（n=29）在 3 个月时平均下降 0.15±0.63，在 6 个月时平均下降 0.18±0.73。调整基线后，两组间的差异为-0.22（95%CI，-0.54 至 0.10），在 6 个月时为-0.60（95%CI，-0.85 至-0.36）。在 6 个月时，差异具有统计学意义（P <.001）且具有临床意义（>0.5）。试验期间，未报告与哮喘相关的口服皮质类固醇使用、住院、急诊就诊或因哮喘而缺勤的情况。
教育和定期监测为基础的多学科哮喘管理模式可能改善产妇哮喘结局，并且可以在临床实践中广泛实施。
澳大利亚和新西兰临床试验注册中心；编号：ACTRN12612000681853；网址：www.anzctr.org.au。
