Enrolment in an Asthma Management Program during Pregnancy and Adherence with Inhaled Corticosteroids: The ‘Management of Asthma during Pregnancy' Program

Background: Poor adherence with inhaled corticosteroids (ICS) is a major problem in asthma and according to previous studies not least during pregnancy. Objective: Our aim was to assess if enrolment in an asthma management program, and by that close monitoring, can improve self-reported and documented adherence with ICS in pregnant women with asthma. Methods: Pregnant women with doctor-diagnosed asthma, currently being prescribed ICS, referred during a 12-month period to the outpatient respiratory clinic, were consecutively included in the study. They had follow-up visits every 4 weeks during pregnancy. Asthma control was assessed according to GINA guidelines. Self-reported adherence was compared to documented adherence, defined as medical possession rate (MPR), calculated on the basis of filled prescriptions (data from each individuals' medication profile at www.fmk-online.dk). Results: A total of 130 women fulfilled the inclusion criteria, but at the initial visit, 16 women reported no current use of ICS, and the analyses are therefore based on 114 patients. Self-reported adherence to ICS was significantly higher during pregnancy than before pregnancy (73 and 52%, respectively, reporting good adherence; p < 0.001). The actual adherence, i.e. MPR, was also higher during pregnancy than before (46 vs. 28%, p < 0.0001). In keeping with this, an overall improvement was also observed in asthma control. Of the women with a low pre-pregnancy MPR, 71% had moderate or good adherence (MPR) during pregnancy. Self-reported adherence was significantly correlated with MPR during pregnancy (p = 0.004) but not before pregnancy (p = 0.46). At the 3-month postpartum visit, adherence was close to the pre-pregnancy level. Conclusion: Enrolment in an asthma management program during pregnancy seems to improve adherence with controller medication, but self-reported adherence is not a valid measure for actual adherence in patients with asthma.