Multidisciplinary approach to management of maternal asthma (MAMMA [copyright]): the PROTOCOL for a randomized controlled trial

Abstract

BackgroundUncontrolled asthma during pregnancy is associated with the maternal hazards of disease exacerbation, and perinatal hazards including intrauterine growth restriction and preterm birth. Interventions directed at achieving better asthma control during pregnancy should be considered a high priority in order to optimise both maternal and perinatal outcomes. Poor compliance with prescribed asthma medications during pregnancy and suboptimal prescribing patterns to pregnant women have both been shown to be contributing factors that jeopardise asthma control. The aim is to design and evaluate an intervention involving multidisciplinary care for women experiencing asthma in pregnancy.Methods/designA pilot single-blinded parallel-group randomized controlled trial testing a Multidisciplinary Approach to Management of Maternal Asthma (MAMMA©) which involves education and regular monitoring. Pregnant women with asthma will be recruited from antenatal clinics in Victoria, Australia. Recruited participants, stratified by disease severity, will be allocated to the intervention or the usual care group in a 1:1 ratio. Both groups will be followed prospectively throughout pregnancy and outcomes will be compared between groups at three and six months after recruitment to evaluate the effectiveness of this intervention. Outcome measures include Asthma Control Questionnaire (ACQ) scores, oral corticosteroid use, asthma exacerbations and asthma related hospital admissions, and days off work, preventer to reliever ratio, along with pregnancy and neonatal adverse events at delivery. The use of FEV1/FEV6 will be also investigated during this trial as a marker for asthma control.DiscussionIf successful, this model of care could be widely implemented in clinical practice and justify more funding for support services and resources for these women. This intervention will also promote awareness of the risks of poorly controlled asthma and the need for a collaborative, multidisciplinary approach to asthma management during pregnancy. This is also the first study to investigate the use of FEV1/FEV6 as a marker for asthma control during pregnancy.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12612000681853)

Untitled

“…12,13 Studies have demonstrated several improved outcomes as a result of a Multi-D approach to complex maternal-fetal care, including changes in diagnosis, antenatal and postnatal management, timing of delivery, improvement in emotional, social and financial family well-being, and implementation of protocols that improve long-term outcomes. [12][13][14][15][16][17] In 2011, the American College of Obstetricians and Gynecologists recommended that the organization and governance of centers involved in fetal intervention should involve a Multi-D team of health care providers. 18 For several reasons, MFM specialists are well suited to coordinate Multi-D care of the complex maternal-fetal dyad: they are often the first member of the team to interact with the patient and therefore possess a unique opportunity to establish rapport and trust with the family, 8 and, by nature of their subspecialty training and knowledge of abnormal maternal and neonatal physiology may refine the fetal diagnosis, alter the antepartum management or guide the intrapartum process with the help of additional subspecialty providers.…”

Asthma management during pregnancy: how long before we can all breathe a little easier?

“…This restricts the generalisability of this approach given the high proportion of asthmatic women who also smoke during pregnancy (420%) [3]. In addition, it has been suggested that the applicability of F E NO to routine clinical settings may be further limited due to issues around clinical expertise, expense and accessibility [7]. Most important, use of FENO is not a stand-alone approach towards improving asthma management, and does not replace the need for appropriate asthma self-management education.…”

“…Therefore, current asthma management appears to be focused on a reactive, not proactive, approach. This is highlighted through only 5-15% of asthmatic pregnant women involved in previous studies reporting having a current asthma action plan [6,7].…”

“…Most recently, evidence in support of the provision of asthma self-management education during pregnancy is provided through another Australian RCT [7]. Participants with current asthma (N ¼ 60) were recruited up until 20 weeks gestation from the antenatal clinic and randomised to either standardised usual care or a pharmacist-led intervention consisting of multidisciplinary care, education and regular monthly monitoring of asthma throughout pregnancy.…”

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

“…295 It is feasible for this to be achieved by pharmacist-clinician collaboration, with monthly telephone monitoring of asthma symptom control. 296 Respiratory infections should be monitored and managed appropriately during pregnancy. 289 During acute asthma exacerbations, pregnant women may be less likely to be treated appropriately than non-pregnant patients.…”