Treatable traits in pregnant women with asthma: a retrospective study of prevalence and associations with exacerbation and poor asthma control.

Abstract

Treatable traits personalize asthma management, yet their prevalence and associations with exacerbations and asthma control in pregnancy are understudied. To determine the prevalence of 18 treatable traits and their associations with exacerbations and asthma control in pregnant women with asthma. Breathing for Life Trial clinical records were examined to identify 18 potential treatable traits from mid-pregnancy. Regression models adjusted for confounders determined associations with future exacerbations during pregnancy. In a sub-group, traits associated with asthma control were assessed at multiple timepoints during pregnancy using a generalized linear mixed model. Pregnant women (n= 761) with mild-moderate asthma exhibited a median of 36% of possible traits assessed. Prevalent treatable traits included no asthma action plan (84.2%); inhaler device polypharmacy (82.1%) and iron deficiency (70.4%). History of exacerbation (aOR 2.47, 95% CI 1.61, 3.78); p<0.002 and significant nausea (aOR 1.88, 95% CI 1.24, 2.85); p=0.039 were associated with increased exacerbation whilst history of exacerbation was associated with increasing exacerbations (aIRR 2.26, 95% CI 1.51, 3.40); p=0.002 after adjusting for confounders and multiple comparisons. In mid-pregnancy, inhaler device polypharmacy (OR 2.72, 95% CI 2.08, 3.57); p=0.002, current smoking (OR 2.51, 95% CI 1.36, 4.63); p=0.039; and history of exacerbation (OR 1.95, 95% CI 1.26, 3.02); p=0.039; were associated with poorer asthma control. Behavioral/risk factor traits are common in asthma during pregnancy. History of exacerbation and significant nausea were associated with increased exacerbation risk. Inhaler device polypharmacy, smoking and history of exacerbations were associated with poor asthma control in mid-pregnancy.