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Level of Knowledge, Concerns and Adherence to Asthma Management Guideline Recommendations Among Healthcare Providers in Midwestern USA
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Jonathan M. Rodrigues, MD, Carrie N. Caruthers, MD, Josiah Moulton, DO, Venkatkiran Kanchustambham, MD, Roua Azmeh, MD, Anthony Kruse, MD, Roula Altisheh, MD, Christopher Sutton, DO, Mark S. Dykewicz, MD FAAAAI, Raymond Slavin, MD FAAAAI
Rationale: Asthma in pregnancy (AiP) carries an increased risk of prenatal and perinatal complications, with possible worsening of asthma. Studies from Australia, India and Spain show a knowledge deficit among physicians pertaining to AiP, but no similar studies have been performed in the USA. 

Methods: A cross-sectional survey to assess knowledge and practice trends about AiP was sent to Midwestern USA physicians in allergy-immunology (AI), pulmonology (PU), internal medicine (IM), emergency medicine (EM), family medicine (FM), and obstetrics-gynecology (OB).

Results: Of 325 responses, 50% would monitor AiP monthly, 34% once/trimester and 14% only PRN. Although 46%-55% of all respondents (AR) considered montelukast safe in pregnancy, 35% would discontinue montelukast in patients with well-controlled AiP. Of the 35%, 10% would continue only PRN albuterol, whereas 25% would switch to inhaled corticosteroids (ICS). 81%AI/94%PU/60%IM/24%EM/68%FM/66%OB would add long acting bronchodilators for a pregnant woman not well-controlled with ICS. Although 53%AR considered oral corticosteroids (OCS) safe in the first trimester and 69% in later trimesters, only 34%AI/33%PU/9%IM/21%EM/13%FM/38%OB would prescribe OCS to a pregnant woman suffering an asthma exacerbation. 61%AI/17%PU consider omalizumab safe in the first trimester and 64%AI/31%PU in later trimesters. It was encouraging that 90%AI would continue allergen immunotherapy without dose escalation in pregnancy, in adherence with practice guidelines. 19%AI/74%PU/89%IM/82%EM/66%FM/61%OB felt they lacked expertise in managing AiP.

Conclusions: There is some mismatch - more pronounced in some specialties - between the knowledge and practice trends of physicians and current management guidelines for AiP, underscoring the need for further dissemination and education about guideline recommendations.