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Table 1 Key features of studies included in the final review

From: The effectiveness of non-pharmacological healthcare interventions for asthma management during pregnancy: a systematic review

First Author, Year, study

Aim

Setting; country

Population

Study design

Interventions

Follow-up

Outcomes

Results

Murphy, 2005 [36] “Education program”

To determine the level of asthma self-management skills and knowledge, and to implement an asthma education program

Antenatal clinics; NSW, Australia

Pregnant women with a doctor’s diagnosis of asthma (mild, moderate, severe) at ~ 20 weeks gestation

Pre-and post-

I: Received education about asthma control and self-management skills from a nurse (asthma educator) in two visits each consisting of a 30-60 min session (n = 211) C: no control group

~33 week s of gestation (last visit)

Self-reported nonadherence to ICS, lung function (FEV1, FEV1%, FVC, FEV1/FVC), symptoms and reliever medication use.

Non-adherence to ICS decreased (p = 0.006). FEV1(l) at first visit1: mild: 3.14 ± 0.05 moderate: 2.87 ± 0.08 severe: 2.87 ± 0.09 FEV1(l) at last visit1: mild: 3.13 ± 0.08 moderate: 2.91 ± 0.12 severe: 2.95 ± 0.10. No significant difference in lung function, symptoms and reliever medication use between the two visits.

Nickel, 2006 [37] “Progressive Muscle Relaxation (PMR)”

To examine the efficacy of PMR in pregnant women

Psychosomatic clinics; Germany, Austria

Pregnant women with asthma who were regularly seen by an obstetrician/ gynecologist

RCT

I: 30 min PMR session, 3 times a week (n = 32) C: placebo (30 min sham training), 3 times a week (n = 32)

8 weeks from baseline

Lung function (PEF, FEV1), QoL (SF-36)

FEV1(l): initial2: I: 1.69 ± 0.6 C: 1.75 ± 0.5 final2: I: 2.22 ± 0.5 C: 1.75 ± 0.5 Difference in FEV1[95%CI] = 0.5 (0.2 to 0.8) p = 0.005 Difference in SF-36 (mental health component)[95%CI] = 5.8 (1.4 to 10.2) p = 0.01

Powell, 2011 [38] “FeNO based Algorithm”

To test the hypothesis that a management algorithm for asthma in pregnancy based on FeNO and symptoms would reduce asthma exacerbations

Antenatal clinics; NSW, Australia

Non-smoking pregnant women (aged ≥ 18 years) with asthma, 12 – 20 weeks gestation and using asthma medications (e.g. inhaled therapy, beta2-agonist) within the past year

Double-blind RCT

I: FeNO algorithm to adjust therapy: (1) FeNO concentration was used to adjust the dose of inhaled corticosteroids (2) ACQ score was used to adjust the dose of long acting beta2-agonist (n = 111) C: ACQ- based clinical algorithm (n = 109)

monthly until delivery

Exacerbation types (unscheduled doctor visits, OCS use, hospital admission, ER/labor ward visits), QoL (SF-12 and AQLQ-M), Lung function (FEV1 and FEV1%), current treatment and perinatal outcomes

Significant reduction in unscheduled doctor visits for asthma (p = 0.002) and OCS use (p = 0.042), QoL (SF-12 mental health component) higher in FeNO group (p = 0.008) – remained significantly different after adjustment for baseline values (p = 0.037), AQLQ-M scores were low at the completion of the study and not different between the groups. FEV1(l) at randomisation3: I: 3.05 (2.96 – 3.14) C: 3.06 (2.96 – 3.15) FEV1(l) at end of study3: I: 3.09 (3.0 – 3.17) C: 3.01 (2.91 – 3.10) No significant difference in lung function.

  1. Data are presented as 1) mean ± SE, 2) mean ± SD, 3) mean [95% Confidence Interval].
  2. ACQ = Asthma Control Questionnaire, AQLQ-M = Asthma Quality of Life Questionnaire-Marks, C = Control, FeNO = Fractional exhaled Nitric Oxide, FEV1 = Forced expiratory volume in 1 second, FVC = Forced vital capacity, ICS = Inhaled corticosteroid, I = intervention, min = minute, l = liter, OCS = Oral corticosteroid, PEF = Peak expiratory flow rate, QoL = Quality of Life, RCT = Randomized Controlled Trial, SF-36 = Short Form 36, SF-12 = Short Form 12.