Division of Pulmonary, Allergy, and Critical Care, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa.
Division of Pulmonary, Allergy, and Critical Care, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pa.
J Allergy Clin Immunol Pract. 2021 Oct;9(10):3672-3678. doi: 10.1016/j.jaip.2021.05.007. Epub 2021 May 24.
It is unknown how active asthma management influences symptom control among inner-city pregnant women who have unique exposures and socioeconomic limitations affecting their care.
To assess the impact of an integrated subspecialty intervention composed of education and monitoring on asthma control among underserved women in an antenatal clinic setting.
We conducted a prospective cohort study of pregnant asthmatic patients participating in a subspecialty clinic integrated into routine prenatal care. We compared baseline characteristics and objective measurements of asthma control between women at an initial visit and those who were evaluated in at least one follow-up. For follow-up, we measured symptom control at successive visits and the incidence of asthma-related complications.
Among 85 women enrolled, 53 (62.4%) returned for at least one follow-up visit. Mean baseline Asthma Control Test scores were similarly low (≤19) between groups (one or more follow-up and no follow-up), as were self-administered Asthma Quality of Life Questionnaire scores (<4.7). A total of 72 women had inadequate asthma control resulting in step-up therapy after the initial visit (84.7%). There was a significant increase in ACT scores between the initial and first follow-up visits. For those with an intervening self-administered Asthma Quality of Life Questionnaire, there was also a significant increase by 1.39 ± 0.67 (P = .0003).
We found that uncontrolled asthma is common among urban women seeking routine obstetric care. Our results suggest that even one interventional visit can result in significant improvement in asthma control. Further investigation into mechanisms for optimizing treatment strategies may improve the quality of asthma care during pregnancy in this underserved population.
目前尚不清楚积极的哮喘管理如何影响具有独特暴露和影响其护理的社会经济限制的城市内孕妇的症状控制。
评估由教育和监测组成的综合亚专科干预措施对产前诊所中服务不足的女性哮喘控制的影响。
我们对参加亚专科诊所的孕妇哮喘患者进行了前瞻性队列研究，该诊所整合到常规产前护理中。我们比较了在初始就诊时和至少随访一次的女性的哮喘控制的基线特征和客观测量结果。对于随访，我们在连续就诊时测量症状控制情况，并评估哮喘相关并发症的发生情况。
在 85 名入组的女性中，有 53 名（62.4%）至少随访一次。两组的哮喘控制测试评分（≤19）均较低（一次或多次随访和无随访），自我管理的哮喘生活质量问卷评分（<4.7）也较低。共有 72 名女性哮喘控制不足，在初次就诊后需要升级治疗（84.7%）。ACT 评分在初始就诊和第一次随访之间显著增加。对于有中间自我管理的哮喘生活质量问卷的患者，评分也显著增加了 1.39±0.67（P=0.0003）。
我们发现，寻求常规产科护理的城市女性中，哮喘控制不佳很常见。我们的结果表明，即使一次干预性就诊也可能导致哮喘控制显著改善。进一步研究优化治疗策略的机制可能会改善该服务不足人群怀孕期间的哮喘护理质量。
