Telehealth for optimising asthma management during pregnancy

Background: Evidence suggests that poorly controlled asthma during pregnancy is hazardous for both the mother and foetus. Some pregnant women with asthma may have few symptoms, but their lung function may be abnormal, putting the health of mother and foetus at risk. Forced expiratory volume in six seconds (FEV₆) has been shown to be equivalent to Forced vital capacity (FVC). Telehealth has the potential to improve asthma management through regular monitoring of lung function and/or asthma symptoms. This research aimed to develop and evaluate the application of a telehealth program for supporting asthma management in pregnant women. Methods: In phase 1, a systematic review of the literature was carried out to evaluate the non-pharmacological health care interventions for asthma management in pregnant women. In phase 2, a prospective cohort study was conducted to investigate the changes in lung function and the role of objective measures of lung function (forced expiratory volume in one second [FEV₁ ], FEV₆ and FVC) for monitoring asthma during pregnancy in healthy (n = 20) and pregnant women with asthma (n = 20). Lung function (pre-bronchodilator) was measured three times at gestational weeks 11 – 20, 21 – 28, and 29 – 40. The results from phase 2 informed phase 3, which was a randomised controlled trial evaluating a telehealth program for asthma management during pregnancy. Phase 3 evaluated Management of Asthma with Supportive Telehealth of Respiratory function in Pregnancy (MASTERY©) compared to usual care in 72 pregnant women with asthma. The intervention group (MASTERY) was provided with the handheld COPD-6 device to measure lung function (FEV₁ and FEV₆) daily, Breathe-easy© application installed on a loaned mobile phone and an individualised written asthma action plan (WAAP). The control group (usual care) received standard antenatal care provided by their health care professionals. Both groups were followed prospectively and their asthma control scores were compared using Juniper’s Asthma Control Questionnaire (ACQ) at 3 and 6 months. Key findings: Phase 1: Significant improvements in maternal asthma control (lung function and quality of life) and neonatal outcomes (birth weight) were found in those who received interventions involving progressive muscle relaxation (PMR) and Fraction of exhaled Nitric Oxide (FeNO) guided algorithm. Interventions that enable pregnant women to be monitored regularly using objective measures of lung function or asthma symptoms appear to be effective in reducing asthma exacerbations during pregnancy. Phase 2: During pregnancy, lung function declined both in healthy women and women with asthma at weeks 21 – 28 (more markedly in those with asthma) but then improved at weeks 29 – 40 (more markedly in those with asthma ). In those with asthma, asthma control scores increased, while quality of life scores declined at weeks 21-28; whilst at weeks 29 – 40 these changes were in the opposite direction. The correlation between FEV₆ and forced vital capacity (FVC) in women with asthma was high (Pearson’s r = 0.88, p < 0.01). Phase 3: The demographic, maternal and clinical characteristics were similar in both groups at baseline. At 6 months, compared to the usual care group, the intervention (MASTERY) group had significantly greater improvement in their asthma control (p = 0.02) and asthma-related quality of life (p = 0.002) scores. At the end of the study, the MASTERY group had significantly higher proportion of participants with well controlled asthma, and more participants with an improvement in ACQ scores greater than 0.5, the minimum clinically important difference (MCID). There were no significant differences between the two groups in lung function, unscheduled healthcare visits, days off work/study, oral corticosteroid use and perinatal outcomes. No significant differences between groups were found at 3 months. Conclusions: The findings from this research confirm that asthma management involving regular monitoring of lung function and asthma symptoms is feasible and could potentially improve asthma control in pregnant women. In pregnant women with asthma, FEV₆ may be a suitable alternative to FVC. A telehealth program (Breathe-easy©) in conjunction with a handheld COPD-6 device for monitoring lung function (FEV₁ and FEV₆) and assessing asthma symptoms and a WAAP can promote asthma self-management during pregnancy and lead to better asthma control.