title: Asthma morbidity during pregnancy can be predicted by severity classification.
abstract: BACKGROUND
  The 1993 National Asthma Education Program Working Group on Asthma and Pregnancy defined asthma severity as mild, moderate, or severe on the basis of symptoms and spirometry, but no studies have evaluated the relationship between this classification system and subsequent asthma morbidity during pregnancy.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the relationship between asthma severity classification during pregnancy and gestational asthma exacerbations.
  
  
  METHODS
  Asthma severity was defined according to the 1993 classification, adjusted to include medication requirements, in a volunteer sample of 1739 pregnant asthmatic patients who were less than 26 weeks' gestation.
  
  
  RESULTS
  Initial asthma classification (mild, moderate, or severe) was significantly related to subsequent asthma morbidity during pregnancy (hospitalizations, unscheduled visits, corticosteroid requirements, and asthma symptoms during labor and delivery). Exacerbations during pregnancy occurred in 12.6% of patients initially classified as mild, 25.7% of patients classified as moderate, and 51.9% of patients classified as severe (P <.001). Asthma morbidity was similar, whether patients were classified as moderate or severe by symptoms and spirometry or by medication requirement. Thirty percent of initially mild patients were reclassified as moderate-severe during pregnancy, and 23% of the initially moderate-severe patients were reclassified as mild later in pregnancy; asthma morbidity in these patients changed accordingly.
  
  
  CONCLUSIONS
  The National Asthma Education Program Working Group on Asthma and Pregnancy classification of asthma severity, adapted to include medication use, predicts subsequent asthma morbidity during pregnancy.
authors.affiliation: Department of Allergy, Kaiser Permanente, San Diego, CA 92111, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Schatz
authors.forename: Mitchell P
authors.initials: MP
authors.lastname: Dombrowski
authors.forename: Robert
authors.initials: R
authors.lastname: Wise
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Thom
authors.forename: Mark
authors.initials: M
authors.lastname: Landon
authors.forename: William
authors.initials: W
authors.lastname: Mabie
authors.forename: Roger B
authors.initials: RB
authors.lastname: Newman
authors.forename: John C
authors.initials: JC
authors.lastname: Hauth
authors.forename: Marshall
authors.initials: M
authors.lastname: Lindheimer
authors.forename: Steven N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Leveno
authors.forename: Paul
authors.initials: P
authors.lastname: Meis
authors.forename: Menachem
authors.initials: M
authors.lastname: Miodovnik
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: Richard H
authors.initials: RH
authors.lastname: Paul
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: O'sullivan
authors.forename: Gary R
authors.initials: GR
authors.lastname: Thurnau
authors.forename: Deborah
authors.initials: D
authors.lastname: Conway
authors.forename: Donald
authors.initials: D
authors.lastname: McNellis
mesh_terms: D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000503:physiopathology*; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D012129:Respiratory Function Tests; D012720:Severity of Illness Index
chemical_list: D018927:Anti-Asthmatic Agents