Multidisciplinary Approach to Management of Maternal Asthma (MAMMA): a randomized controlled trial

Chest. 2014 May;145(5):1046-1054. doi: 10.1378/chest.13-2276.


Background: Uncontrolled asthma during pregnancy is associated with maternal and perinatal hazards. A pharmacist-led intervention directed at improving maternal asthma control, involving multidisciplinary care, education, and regular monitoring to help reduce these risks, was developed and evaluated.

Methods: A randomized controlled trial was carried out in the antenatal clinics of two major Australian maternity hospitals. Sixty pregnant women < 20 weeks gestation who had used asthma medications in the previous year were recruited. Participants were randomized to either an intervention or a usual care group and followed prospectively throughout pregnancy. The primary outcome was Asthma Control Questionnaire (ACQ) score. Mean changes in ACQ scores from baseline were compared between groups at 3 and 6 months to evaluate intervention efficacy.

Results: The ACQ score in the intervention group (n = 29) decreased by a mean ± SD of 0.46 ± 1.05 at 3 months and 0.89 ± 0.98 at 6 months. The control group (n = 29) had a mean decrease of 0.15 ± 0.63 at 3 months and 0.18 ± 0.73 at 6 months. The difference between groups, adjusting for baseline, was -0.22 (95% CI, -0.54 to 0.10) at 3 months and -0.60 (95% CI, -0.85 to -0.36) at 6 months. The difference at 6 months was statistically significant (P < .001) and clinically significant (> 0.5). No asthma-related oral corticosteroid use, hospital admissions, emergency visits, or days off from work were reported during the trial.

Conclusions: A multidisciplinary model of care for asthma management involving education and regular monitoring could potentially improve maternal asthma outcomes and be widely implemented in clinical practice.

Trial registry: Australian and New Zealand Clinical Trials Registry; No.: ACTRN12612000681853; URL:

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / physiopathology
  • Asthma / therapy*
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume
  • Hospitals, Maternity*
  • Humans
  • Interdisciplinary Communication*
  • Monitoring, Physiologic / methods*
  • Patient Education as Topic / methods*
  • Pharmacists
  • Physicians, Family
  • Pregnancy
  • Pregnancy Complications*
  • Pregnancy Outcome
  • Prenatal Care / methods
  • Prospective Studies
  • Surveys and Questionnaires
  • Treatment Outcome


  • Anti-Asthmatic Agents