Asthma morbidity during pregnancy can be predicted by severity classification

Michael Schatz, Mitchell P. Dombrowski, Robert A Wise, Elizabeth A. Thom, Mark Landon, William Mabie, Roger B. Newman, John C. Hauth, Marshall Lindheimer, Steven N. Caritis, Kenneth J. Leveno, Paul Meis, Menachem Miodovnik, Ronald J. Wapner, Richard H. Paul, Michael W. Varner, Mary Jo O'Sullivan, Gary R. Thurnau, Deborah Conway, Donald McNellis

Research output: Contribution to journalArticle

Abstract

Background: The 1993 National Asthma Education Program Working Group on Asthma and Pregnancy defined asthma severity as mild, moderate, or severe on the basis of symptoms and spirometry, but no studies have evaluated the relationship between this classification system and subsequent asthma morbidity during pregnancy. Objective: The objective of this study was to evaluate the relationship between asthma severity classification during pregnancy and gestational asthma exacerbations. Methods: Asthma severity was defined according to the 1993 classification, adjusted to include medication requirements, in a volunteer sample of 1739 pregnant asthmatic patients who were less than 26 weeks' gestation. Results: Initial asthma classification (mild, moderate, or severe) was significantly related to subsequent asthma morbidity during pregnancy (hospitalizations, unscheduled visits, corticosteroid requirements, and asthma symptoms during labor and delivery). Exacerbations during pregnancy occurred in 12.6% of patients initially classified as mild, 25.7% of patients classified as moderate, and 51.9% of patients classified as severe (P <.001). Asthma morbidity was similar, whether patients were classified as moderate or severe by symptoms and spirometry or by medication requirement. Thirty percent of initially mild patients were reclassified as moderate-severe during pregnancy, and 23% of the initially moderate-severe patients were reclassified as mild later in pregnancy; asthma morbidity in these patients changed accordingly. Conclusion: The National Asthma Education Program Working Group on Asthma and Pregnancy classification of asthma severity, adapted to include medication use, predicts subsequent asthma morbidity during pregnancy.

Original languageEnglish (US)
Pages (from-to)283-288
Number of pages6
JournalThe Journal of Allergy and Clinical Immunology
Volume112
Issue number2
DOIs
StatePublished - Aug 1 2003

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Asthma
Morbidity
Pregnancy
Spirometry
Education
Volunteers
Adrenal Cortex Hormones
Hospitalization

Keywords

  • Asthma
  • Morbidity
  • Pregnancy
  • Severity

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Asthma morbidity during pregnancy can be predicted by severity classification. / Schatz, Michael; Dombrowski, Mitchell P.; Wise, Robert A; Thom, Elizabeth A.; Landon, Mark; Mabie, William; Newman, Roger B.; Hauth, John C.; Lindheimer, Marshall; Caritis, Steven N.; Leveno, Kenneth J.; Meis, Paul; Miodovnik, Menachem; Wapner, Ronald J.; Paul, Richard H.; Varner, Michael W.; O'Sullivan, Mary Jo; Thurnau, Gary R.; Conway, Deborah; McNellis, Donald.

In: The Journal of Allergy and Clinical Immunology, Vol. 112, No. 2, 01.08.2003, p. 283-288.

Research output: Contribution to journalArticle

Schatz, M, Dombrowski, MP, Wise, RA, Thom, EA, Landon, M, Mabie, W, Newman, RB, Hauth, JC, Lindheimer, M, Caritis, SN, Leveno, KJ, Meis, P, Miodovnik, M, Wapner, RJ, Paul, RH, Varner, MW, O'Sullivan, MJ, Thurnau, GR, Conway, D & McNellis, D 2003, 'Asthma morbidity during pregnancy can be predicted by severity classification', The Journal of Allergy and Clinical Immunology, vol. 112, no. 2, pp. 283-288. https://doi.org/10.1067/mai.2003.1516
Schatz, Michael ; Dombrowski, Mitchell P. ; Wise, Robert A ; Thom, Elizabeth A. ; Landon, Mark ; Mabie, William ; Newman, Roger B. ; Hauth, John C. ; Lindheimer, Marshall ; Caritis, Steven N. ; Leveno, Kenneth J. ; Meis, Paul ; Miodovnik, Menachem ; Wapner, Ronald J. ; Paul, Richard H. ; Varner, Michael W. ; O'Sullivan, Mary Jo ; Thurnau, Gary R. ; Conway, Deborah ; McNellis, Donald. / Asthma morbidity during pregnancy can be predicted by severity classification. In: The Journal of Allergy and Clinical Immunology. 2003 ; Vol. 112, No. 2. pp. 283-288.
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abstract = "Background: The 1993 National Asthma Education Program Working Group on Asthma and Pregnancy defined asthma severity as mild, moderate, or severe on the basis of symptoms and spirometry, but no studies have evaluated the relationship between this classification system and subsequent asthma morbidity during pregnancy. Objective: The objective of this study was to evaluate the relationship between asthma severity classification during pregnancy and gestational asthma exacerbations. Methods: Asthma severity was defined according to the 1993 classification, adjusted to include medication requirements, in a volunteer sample of 1739 pregnant asthmatic patients who were less than 26 weeks' gestation. Results: Initial asthma classification (mild, moderate, or severe) was significantly related to subsequent asthma morbidity during pregnancy (hospitalizations, unscheduled visits, corticosteroid requirements, and asthma symptoms during labor and delivery). Exacerbations during pregnancy occurred in 12.6{\%} of patients initially classified as mild, 25.7{\%} of patients classified as moderate, and 51.9{\%} of patients classified as severe (P <.001). Asthma morbidity was similar, whether patients were classified as moderate or severe by symptoms and spirometry or by medication requirement. Thirty percent of initially mild patients were reclassified as moderate-severe during pregnancy, and 23{\%} of the initially moderate-severe patients were reclassified as mild later in pregnancy; asthma morbidity in these patients changed accordingly. Conclusion: The National Asthma Education Program Working Group on Asthma and Pregnancy classification of asthma severity, adapted to include medication use, predicts subsequent asthma morbidity during pregnancy.",
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AU - Mabie, William

AU - Newman, Roger B.

AU - Hauth, John C.

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AU - Caritis, Steven N.

AU - Leveno, Kenneth J.

AU - Meis, Paul

AU - Miodovnik, Menachem

AU - Wapner, Ronald J.

AU - Paul, Richard H.

AU - Varner, Michael W.

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AU - Conway, Deborah

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N2 - Background: The 1993 National Asthma Education Program Working Group on Asthma and Pregnancy defined asthma severity as mild, moderate, or severe on the basis of symptoms and spirometry, but no studies have evaluated the relationship between this classification system and subsequent asthma morbidity during pregnancy. Objective: The objective of this study was to evaluate the relationship between asthma severity classification during pregnancy and gestational asthma exacerbations. Methods: Asthma severity was defined according to the 1993 classification, adjusted to include medication requirements, in a volunteer sample of 1739 pregnant asthmatic patients who were less than 26 weeks' gestation. Results: Initial asthma classification (mild, moderate, or severe) was significantly related to subsequent asthma morbidity during pregnancy (hospitalizations, unscheduled visits, corticosteroid requirements, and asthma symptoms during labor and delivery). Exacerbations during pregnancy occurred in 12.6% of patients initially classified as mild, 25.7% of patients classified as moderate, and 51.9% of patients classified as severe (P <.001). Asthma morbidity was similar, whether patients were classified as moderate or severe by symptoms and spirometry or by medication requirement. Thirty percent of initially mild patients were reclassified as moderate-severe during pregnancy, and 23% of the initially moderate-severe patients were reclassified as mild later in pregnancy; asthma morbidity in these patients changed accordingly. Conclusion: The National Asthma Education Program Working Group on Asthma and Pregnancy classification of asthma severity, adapted to include medication use, predicts subsequent asthma morbidity during pregnancy.

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