The influence of asthma control on psychosocial outcomes for pregnant women with asthma

Objective: To investigate the relationship between asthma control and psychosocial outcomes in pregnant women with asthma. Methods: Secondary analysis (N=221) of a randomized controlled trial of treatment adjustments, based on fractional exhaled nitric oxide versus clinical guideline-based algorithms. Psychosocial variables included generic and asthma-specific quality of life (SF12, AQLQ-M), illness perceptions (BIPQ), perceived control (PCAQ), perceived risk of side effects (PRSE) and anxiety (STAI-6). Asthma control was defined as controlled (Asthma Control Questionnaire (ACQ7)≤1.5 at randomization and end of study), improved (ACQ7>1.5 at randomization and ≤1.5 at end of study) and unimproved (ACQ7>1.5 at end of study). Regression models were fitted for each psychosocial measure at the end of the study, with adjustment for baseline values and smoking status, with predictor variable asthma control. Results: Women with unimproved asthma had poorer physical (SF12, p=0.012) and asthma-specific quality of life across all domains (AQLQ-M, p≤0.012) compared to women with controlled asthma. They believed that they had less control over their asthma (PCAQ total p=0.014), had more symptoms and that their illness had a greater effect on their emotions and their lives in general (BIPQ identity, consequences, concern, emotional response p≤0.015). Women with improved asthma control had significantly lower AQLQ-M breathlessness (p=0.048) and lower total scores (p=0.04) than women with controlled asthma. Conclusions: Pregnant women who are not able to get control of their asthma symptoms may experience worse quality of life and are likely to have more negative perceptions about their condition.