Level of Knowledge, Concerns and Adherence to Asthma Management Guideline Recommendations Among Healthcare Providers in Midwestern USA

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.