Multidisciplinary Approach to Management of Maternal Asthma (MAMMA): A Randomized Controlled Trial.
Chest. 2014 Feb 13. doi: 10.1378/chest.13-2276.
Lim AS, Stewart K, Abramson MJ, Walker SP, Smith CL, George J.
BACKGROUND 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.
METHODS 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 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.
RESULTS 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 (-0.85 to -0.36) at 6 months. The difference at 6 months was statistically significant (p<0.001) and clinically significant (>0.5). No asthma-related oral corticosteroid use, hospital admissions, emergency visits or days off work were reported during the trial.
CONCLUSION 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.