GPs warned to be alert for asthma becoming severe in pregnancy
GPs have been urged to be
extra vigilant in their management of asthma in pregnant women because a third of them may find their symptoms become severe, according to research funded by the US government.
The quality framework of the new contract only requires asthma patients to be reviewed every 15 months. It does not flag up pregnancy as a risk
factor in the condition.
But joint guidance from the British Thoracic Society and the Scottish Intercollegiate Guidelines Network released this year state GPs should 'monitor closely' pregnant asthma patients and consider stepping up or down treatment. They also stress the importance of continuing medication.
The multi-centre study of 1,739 pregnant women examined changes in asthma severity graded at the start of the
trial and in monthly follow-ups using spirometry and by monitoring symptoms and medication needs.
Of 811 women with mild asthma, 30 per cent were reclassified moderate to severe during pregnancy, according to the study in last month's Journal of Allergy and Clinical Imunology.
Some 37.4 per cent of reclassifications were due to an exacerbation requiring hospitalisation, an emergency visit or an oral steroid.
A further 18.3 per cent were due to asthma symptoms during labour and/or delivery.
Some 33.7 per cent had an emergency visit due to asthma symptoms and a further 5 per cent were hospitalised.
The study also found 23 per cent of initially moderate to severe patients were reclassified as mild later in pregnancy.
British Thoracic Society adviser Dr David Bellamy said it was as important for GPs to ask pregnant women about their asthma as smoking or
diabetes, and warned them to keep a 'close eye' on them from the start of pregnancy.
'If you know a patient is asthmatic you should probably ask even more in pregnancy because some get worse,' said Dr Bellamy, also a member of the General Practice Airways Group and a GP in Bourne-mouth, Dorset.
'You need to review asthmatics regularly not only from the pregnancy point of view but also asthma,' he warned.