Factors influencing inhaler adherence among pregnant women with controlled asthma attending primary care clinics in Malaysia

Introduction: Asthma is the most common chronic medical condition in pregnancy, with controlled asthma reducing adverse maternal and perinatal outcomes. We aim to identify factors associated with inhaler adherence among pregnant women with controlled asthma attending primary care clinics. Method: A cross-sectional study was conducted among 120 pregnant women attending 14 primary care clinics in the states of Selangor, Wilayah Persekutuan, Perak, and Johor. Inhaler adherence during pregnancy with sociodemographic factors, antenatal characteristics, organizational support, and patients' perception and management of asthma were analyzed using binary logistic regression. Result: 74.2% (89/120) of women with controlled asthma were adherent to their inhalers but 31% (37/120) had improper inhaler technique. 39% (42/120) required escalation in their inhaler medications during pregnancy. Univariate analysis showed an escalation of treatment (OR=3.56, 95%CI 1.33-9.52 p=0.011 ), consultation by doctor (OR=4.79, 95% CI 1.99- 11.5, p=<0.001) consultation by nurses (OR=2.06, 95%CI 0.94- 4.72, p=0.087) consultation by pharmacist (OR=11.84, 95%CI 2.66-52.65, p=0.001) received asthma action plan (OR=7.72, 95%CI 3.12-19.18, p=<0.001) received asthma diary (OR=3.37 95% CI 1.36- 8.33, p<0.009 )referred to specialist (OR=3.22 95% CI 1.30- 7.96, p<0.001) perception that asthma causes harm to baby (OR=3.45, 95% CI 1.47-8.14, p,0.005) perception inhaled steroid are harmful to baby (OR=0.44, 95%CI 0.19 -1.02, p=0.055) perception that asthma is more harmful than inhaler (OR=2.21, 95%CI 3.03- 22.98, p = <0.001) confident in using asthma action plan (OR=7.79, 95% CI 3.06-19.81, p=<0.001) took initiative to improve knowledge (OR=8.34, 95%CI 3.03-22.98, p=<0.001) trigger avoidance (OR=2.83, 95%CI 1.33-6.03, p<0.007)monitored asthma symptoms (OR=6.59,95% CI 2.15-20.18, p=0.001) Bivariate logistic regression that two factors were most strongly associated with inhaler adherence were consultation by pharmacist (OR=15.63,95%CI 1.58-154.49, p=0.019) and trigger avoidance (OR= 9.73 95% CI 1.02- 92.42, p=0.048). Discussion: Gaps in care still exist among pregnant women with controlled asthma despite inhaler adherence. Emphasis on trigger avoidance and the role of pharmacists need to be enhanced.