Chest
Volume 145, Issue 5, May 2014, Pages 1046-1054
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Original Research
Multidisciplinary Approach to Management of Maternal Asthma (MAMMA): A Randomized Controlled Trial

https://doi.org/10.1378/chest.13-2276Get rights and content

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 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.

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 (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.

Conclusions

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.

Trial registry

Australian and New Zealand Clinical Trials Registry; No.: ACTRN12612000681853; URL: anzctr.org.au

Section snippets

Materials and Methods

A single-blind randomized controlled trial was carried out in the antenatal settings of two large maternity hospitals in Victoria, Australia, to evaluate MAMMA intervention. The detailed protocol is published elsewhere.21 The study design and flow of participants are shown in Figure 1.

Results

Sixty participants from a range of ethnic and socioeconomic groups were recruited into the trial. At baseline, the groups were well matched (Table 1). All participants reported that they were nonsmokers or had quit smoking upon confirmation of pregnancy. At the baseline interview, 42 participants (70%) revealed that they were unaware of the risks of poorly controlled asthma, and 19 (32%) reported ceasing or reducing their medications since becoming pregnant. Sixteen participants (27%) (10 in

Discussion

This trial shows that an intervention comprising education, surveillance, and multidisciplinary management can successfully overcome barriers to asthma management in pregnancy, translating into improved asthma control. This intervention is simple and could be easily implemented in antenatal settings with minimal additional resources. Although the intervention was pharmacist led, it could potentially be delivered by any member of the health-care team with additional training in asthma

Conclusions

The MAMMA trial has shown that actively managing asthma through education and regular monitoring by a pharmacist-led multidisciplinary team can improve asthma control during pregnancy. Empowering women to take control of this common chronic health condition and providing them with more support services will reduce the burden of asthma during pregnancy and potentially reduce poor health outcomes associated with exacerbations.

Acknowledgments

Author contributions: Dr George had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Ms Lim: contributed to the trial design and management, participant recruitment, baseline data collection, data entry, drafting of the manuscript, and editing the manuscript based on comments and feedback from the other authors.

Dr Stewart: contributed to the trial design and review of the manuscript.

Dr Abramson: contributed to

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    Part of this article has been presented as an oral presentation at the Tackling Asthma 2013 Conference, March 19-20, 2013, Canberra, ACT, Australia; as a poster presentation at the Thoracic Society of Australia and New Zealand Annual Scientific Meeting, March 23-27, 2013, Darwin, NT, Australia; and as a poster presentation at the European Academy of Allergy and Clinical Immunology & World Allergy Organization World Allergy & Asthma Congress, June 22-26, 2013, Milan, Italy.

    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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