Published online: March 7, 2018
Asthma is the most common medical complication in pregnancy. Poor asthma control in pregnancy is strongly associated with the onset of childhood asthma in the offspring. Whether better asthma management in pregnancy can prevent the development of childhood asthma has not been studied.
In an article recently published in The Journal of Allergy & Clinical Immunology (JACI), Morten and colleagues followed up the asthma status in preschool-aged children born to 179 asthmatic mothers who participated in the Managing Asthma in Pregnancy (MAP) trial in Newcastle, Australia, during their pregnancy. In this trial, one group of pregnant women were randomly allocated to an asthma management approach that took into account their asthma control only in accordance with current practice (clinical group). The other group was allocated to a treatment approach that in addition considered the levels of a lung inflammation marker by measuring the fraction of exhaled nitric oxide in the breath (FeNO). The MAP trial showed that the FeNO-guided asthma management reduced asthma attacks in pregnancy by half.
The authors found a significant reduction in asthma diagnosis from 43% in children born to mothers from the clinical group to 26% in children born to mothers from the FeNO group. Asthma symptoms, emergency department visits for asthma and use of reliever asthma medication were also significantly less common in children from the FeNO group. The effect of FeNO-guided asthma management on childhood asthma was mediated by more appropriate and earlier use of inhaled steroid asthma preventer medication during pregnancy.
Monitoring the level of lung inflammation in asthmatic women during pregnancy in order to decide when to start and adjust preventer medication modified the time for the onset of early onset childhood asthma in the offspring. This study supports the clinical consensus that the benefits of inhaled steroid asthma preventer therapy in pregnancy, where indicated, largely outweigh any of the potential risks.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.