Inhaler Adherence and its Associated Factors among Pregnant Women with Controlled Asthma Attending Selected Primary Care Clinics in Malaysia

Abstract

Inhaler adherence particularly inhaled Corticosteroid (ICS) is essential among pregnant women with asthma to improve maternal and fetal outcome. This study identified factors associated with inhaler adherence among pregnant women with controlled asthma. Data from self-administered questionnaires and clinical audits were sampled among 369 pregnant women with controlled asthma attending 16 government primary care clinics in the four states in Malaysia between December 2023 to March 2024. Binary logistic regression was used to determine the association between sociodemographic characteristics, clinical parameters, organizational support and patients’ knowledge, perception and practices with inhaler adherence during pregnancy. Factors associated with increased likelihood of inhaler adherence were controlled asthma without depression (OR=3.73, 95%CI 2.78-7.79) and referral to pharmacists (OR=5.82, 95%CI 1.88-11.31). Factors associated with reduced inhaler adherence were; wrong inhaler techniques (OR=0.77, 95%CI 0.30-0.96), unable to differentiate between ICS and short-acting beta-agonists (OR=0.60, 95%CI 1.19-1.41), explanation not given on asthma action plan (OR=0.43, 95%CI 0.26-0.49), explanation not given on asthma diary (OR=0.70, 95%CI 0.21-0.95), not referred to primary care physicians (OR=0.55, 95%CI 0.33-0.70), did not practice trigger avoidance (OR=0.20, 95%CI 0.05-0.79), lacking confidence in using the asthma action plan (OR=0.62, 95%CI 0.33-0.58), and not using asthma diaries (OR=0.58, 95%CI 0.37-0.79). Consultation on self-management skills, asthma action plan, asthma diary and correct inhaler technique with a multidisciplinary team approach is needed to ensure inhaler adherence among pregnant women with controlled asthma.