title: Systemic corticosteroids for the treatment of asthma exacerbations during and outside of pregnancy in an acute-care setting.
abstract: BACKGROUND
  Asthma exacerbations are common during pregnancy with a prevalence as high as 51.9% among women with severe asthma.
  
  
  OBJECTIVE
  To compare the treatment of asthma exacerbations in an acute-care setting during and outside of pregnancy.
  
  
  METHODS
  We formed a cohort of women who sought medical care for an asthma exacerbation at a teaching hospital during or in the year preceding pregnancy, between 1998 and 2008. An exacerbation was composed of one or more medical encounters in an acute-care setting (hospital-based outpatient clinic, emergency department, or during hospitalization). Data were retrieved from medical charts and health administrative databases. We compared the use of systemic corticosteroids (SCSs) during and outside of pregnancy with a Cox proportional hazards model.
  
  
  RESULTS
  The cohort was formed of 39 women who had 40 exacerbations during and 39 exacerbations outside of pregnancy. Use of SCSs to treat exacerbations was less frequent (adjusted hazard ratio: 0.51; 95% CI: 0.31-0.84) during pregnancy. Moreover, upon the first medical encounter related to the exacerbation, SCSs, when administered, were given less frequently to women when pregnant than when non-pregnant (83% vs. 100%). The SCS prescription was filled at the community pharmacy 65% and 67% of the time when it was prescribed at discharge to women when pregnant than when non-pregnant, respectively.
  
  
  CONCLUSIONS
  We observed a reduced and delayed use of SCSs for the treatment of asthma exacerbations in women when pregnant than when non-pregnant, with similar numbers of women in both conditions filling their SCSs prescription in pharmacies.
authors: Faculty of Pharmacy, Université de Montréal, Montréal H3C 3J7, Canada; Pharmacy Department, Centre hospitalier universitaire de Sherbrooke, Sherbrooke J1H 5N4, Canada.
authors: Benoit
authors: B
authors: Cossette
authors: Faculty of Pharmacy, Université de Montréal, Montréal H3C 3J7, Canada; Pharmacy Department, Centre hospitalier universitaire de Sherbrooke, Sherbrooke J1H 5N4, Canada; Centre de recherche Clinique Étienne-Le Bel, Centre hospitalier universitaire de Sherbrooke, Sherbrooke J1H 5N4, Canada; Endowment Chair, AstraZeneca in Respiratory Health, Montréal H3C 3J7, Canada.
authors: Marie-France
authors: MF
authors: Beauchesne
authors: Faculty of Pharmacy, Université de Montréal, Montréal H3C 3J7, Canada; Research Center, Hôpital du Sacré-Coeur de Montréal, Montréal H4J 1C5, Canada.
authors: Amélie
authors: A
authors: Forget
authors: Research Center, Hôpital du Sacré-Coeur de Montréal, Montréal H4J 1C5, Canada; Faculty of Medicine, Université de Montréal, Montréal H3C 3J7, Canada.
authors: Catherine
authors: C
authors: Lemière
authors: Centre de recherche Clinique Étienne-Le Bel, Centre hospitalier universitaire de Sherbrooke, Sherbrooke J1H 5N4, Canada; Faculty of Medicine, Université de Sherbrooke, Sherbrooke J1H 5N4, Canada.
authors: Pierre
authors: P
authors: Larivée
authors: Faculty of Medicine, Université de Montréal, Montréal H3C 3J7, Canada; Department of Obstetrics and Gynecology and Research Center, Centre hospitalier universitaire Ste-Justine, Montréal H3T 1C5, Canada.
authors: Évelyne
authors: É
authors: Rey
authors: Department of Pharmacology, Faculty of Medicine, Université de Sherbrooke, Sherbrooke J1H 5N4, Canada.
authors: Marie
authors: M
authors: Couturier
authors: Department of Pharmacology, Faculty of Medicine, Université de Sherbrooke, Sherbrooke J1H 5N4, Canada.
authors: Claudie
authors: C
authors: Rodrigue
authors: Faculty of Pharmacy, Université de Montréal, Montréal H3C 3J7, Canada; Centre de recherche Clinique Étienne-Le Bel, Centre hospitalier universitaire de Sherbrooke, Sherbrooke J1H 5N4, Canada; Endowment Chair, AstraZeneca in Respiratory Health, Montréal H3C 3J7, Canada; Research Center, Hôpital du Sacré-Coeur de Montréal, Montréal H4J 1C5, Canada. Electronic address: lucie.blais@umontreal.ca.
authors: Lucie
authors: L
authors: Blais
mesh_terms: D000208:Acute Disease; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006784:Hospitals, Teaching; D006801:Humans; D053208:Kaplan-Meier Estimate; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids
keywords: Asthma; Beta-agonist; Cohort; Corticosteroids; Exacerbations; Pregnancy