P211 Asthma in pregnancy: how are we doing? A service evaluation across general asthma and severe asthma clinics in a tertiary hospital. (11th November 2022) - Thomas, A
Abstract : Introduction: Asthma is common and can complicate pregnancy. Uncontrolled asthma is associated with adverse outcomes for both mother and baby. National and regional guidelines advocate good asthma control through continuous monitoring, patient education and stepwise approach to treatment. Objectives: To assess if the Greater Manchester and Eastern Cheshire (GMEC) guidelines are being followed and identify where care can improve. Methods: A prospective service evaluation of 40 women attending Wythenshawe hospital's general asthma clinic (March 2019 – March 2022) and severe asthma clinic (November 2020 – March 2022) Results: Patients attending the general asthma clinic were commonly referred through A&E after an exacerbation which required oral corticosteroids (OCS) figure 1 . These patients often required escalation of treatment, multiple courses of OCS and more frequent follow-up. In contrast, patients attending the severe asthma clinic were already known to the clinic prior to pregnancy, required fewer courses of OCS as well as – figure 1 ; fewer clinic appointments during their pregnancy. Women in the severe asthma clinic on new biologic treatment still required OCS. Overall, adherence to medication was good, however, novel asthma treatments on occasion were stopped by primary care. Furthermore, conversations regarding patients' asthma triggers, flu vaccination and personal asthma action plan were poorly executed, and monitoring wasn't comprehensive. This may have been influenced by a high incidence of telephone consultations, COVID-19 or these conversations occurring verbally. A well-known risk of uncontrolled asthma is delivering via caesarean section, we recorded that many patients in the severe cohort had elective c-sections, however in the general asthma cohort over 50% of our patients required an emergency c-section. Discussion: The high number of emergency c-sections highlights the need to work closer with obstetrics in those patients with asthma, as well as the need for further research to support our findings. GMEC guidelines were poorly adhered to, due to their nonspecific nature. Consequently, a facilitated template is required to provide a simple reminder of the key discussion points and a means to record the important data collected, to optimise asthma care.