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Patients & Consumers Online Tools Find an Allergist / Immunologist Pollen Counts Diseases 101 Drug Guide Featured Resources » AAAAI Tips Brochures Topic of the Month Information Request Form Donate Now Constituencies » Patients & Consumers Contact Search by Condition (A-Z) Request a Speaker Smoke Free Homes Referral Guidelines Breakthroughs in Bioscience Other Resources En Español Just for Kids Seniors		Allergy & Asthma Advocate: Fall 2005 Controlling asthma during pregnancy By Natalio Salmun MD.FAAAAI Asthma prevalence is increasing all over the world. It is also increasing in pregnant women in the last few years. In pregnancy, asthma symptoms appear to worsen, improve or remain unchanged in approximately similar proportions (almost 30% each). A recent study by the National Asthma Education and Prevention Program (NAEPP) found that asthma severity increased in 30% of women and decreased in 23% from the beginning to the end of pregnancy. Asthma severity during pregnancy is significantly more common in women who had persistent or severe-persistent asthma before their pregnancy. In women whose asthma becomes worse during pregnancy, asthma attacks can happen at any time. The period of greatest incidence appears to be in the third trimester, from weeks 24 to 36. In the last month of pregnancy, asthma crisis are usually neither more frequent, nor more severe. Asthma and allergies are frequently under treated by both physicians and patients during pregnancy. This may be due to the fear of adverse effects medication may have on the fetus. Are asthma medications dangerous during pregnancy? During pregnancy, mothers-to-be may feel uneasy taking medications. However, if a pregnant woman has asthma, it is doubly important that her symptoms be well-managed to increase both her health and her baby's health. The goals of asthma management and treatment during pregnancy are the same as for other patients - to prevent hospitalization, emergency room visits, work loss and chronic disability. Medium-dose inhaled corticosteroids and combined low-dose inhaled corticosteroid with a long-acting beta 2 agonist are the preferred choice for the initial management of moderate persistent asthma. Studies and observations of hundreds of pregnant women with asthma have demonstrated that most inhaled asthma medications are appropriate for patients to use while pregnant. The NAEPP recommends three specific drugs: Budesonide (inhaled-corticosteroid), Albuterol (short-acting Beta2 agonist), and Salmeterol (long-acting Beta 2 agonist). Patients whose symptoms are well controlled with another inhaled corticosteroid before pregnancy may continue that drug during pregnancy. Oral corticosteroids are not preferred in the treatment of asthma during pregnancy. However, they can be used to treat severe asthma attacks during pregnancy. Their potential risks are still less than the possible risks of severe uncontrolled asthma. The risks of uncontrolled asthma appear to be greater than the risks of necessary asthma medications. Poorly controlled asthma can lead to serious medical problems for pregnant women and their fetuses. When a pregnant patient has trouble breathing, her fetus also has trouble getting the oxygen it needs. Successful asthma management can reduce adverse perinatal outcomes: preeclampsia (a serious condition marked by high blood pressure, which can cause seizures in the mother or fetus), preterm birth, low birth weight and oral clefts. These risks are linked to asthma severity; the more severe the asthma, the greater the risk, as opposite better-controlled asthma is tied to decreased risks. Women receiving allergen immunotherapy should continue their treatment during their pregnancy if it was started before the pregnancy began. However, it is not recommended to begin immunotherapy during pregnancy. Other important aspects of asthma management during pregnancy are the need to identify and limit the exposure to asthma triggers (allergens like house dust mites, pollens, indoor molds and others, tobacco smokes and irritants, like wood-burning stoves or fireplaces, or other irritants, such as perfumes, cleaning agents, sprays). Assessment and monitoring of asthma includes objective measurement of pulmonary function. Measurement of peak expiratory flow (PEF) with a peak flow meter is generally sufficient. Patient education Asthma control is enhanced by ensuring access to education about asthma and about the skills necessary to manage it: self-monitoring, correct use of inhalers, identifying and limiting exposure to asthma triggers and following a plan for managing asthma long term and for promptly handling signs of worsening asthma. Women with other conditions that can worsen asthma, such as allergic rhinitis, sinusitis, and gastroesophageal reflux should have those conditions treated as well. Such conditions often become more troublesome during pregnancy. Consult with your physician about how to properly manage these conditions. If you have asthma and you think, or you are pregnant, it's important to consult with your physician about your medication. <back>
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