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Asthma management breakthrough for pregnant women

Sep 9 2011

Professor Peter Gibson

An Australian-designed asthma management program has the potential to halve asthma attacks in pregnant women, the most common chronic medical disorder they experience.

HMRI researcher Professor Peter Gibson, a staff specialist at John Hunter Hospital, has developed an algorithm that adjusts inhaled therapies to better match airway inflammation.

Results of a randomised controlled trial published today in the esteemed journal The Lancet found that the asthma exacerbation rate of pregnant women can halve if airway inflammation is closely monitored.

Professor Gibson said improving asthma treatment for pregnant women was a priority.

“While asthma is common in pregnancy, mothers and health professionals try to manage it by keeping drug exposure to the developing foetus to a minimum,” Professor Gibson said.

“Inhaled therapies can effectively reduce the frequency and severity of asthma attacks but treatments based on clinical symptoms alone can lead to over-treatment or under-treatment. Both can have a significant impact on the health of the mother and baby.”

Pilot studies for this research were funded by the Hunter Medical Research Institute (HMRI).

Previous work by Professor Gibson and his team found that steroid-based treatments may be more effective when based on actual measures of airway inflammation with some benefit to sufferers. This research used the fraction of exhaled nitric oxide, or FENO – a direct marker of inflammation.

The latest work – the Managing Asthma in Pregnancy (MAP) study – developed and tested an improved FENO-based algorithm. MAP assessed 220 pregnant, non-smoking women with asthma and compared one group treated using clinical symptoms and another treated using the FENO model. The study was conducted in the antenatal clinics of John Hunter and Maitland hospitals.

“The study found that using the algorithm and symptoms led to a 50 per cent reduction in asthma exacerbations,” Professor Gibson said. “The reduction was accompanied by important changes in asthma management including more frequent use of inhaled steroids, but at a lower total daily dose, and earlier introduction of long-acting treatments.

“Further research is needed to determine whether this approach may also benefit asthma sufferers in general.”

* Professor Peter Gibson is a Hunter New England Health respiratory specialist and Conjoint Professor at the University of Newcastle. He is Co-Director of the University’s Priority Research Centre for Asthma and Respiratory Disease and conducts research in collaboration with HMRI’s Viruses, Infections/Immunity, Vaccines and Asthma (VIVA) Research Program. HMRI is a partnership between the University of Newcastle, Hunter New England Health and the community.