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Targeting asthma exacerbations during pregnancy

Published: August 14, 2021

Asthma is the most common chronic illness in pregnant women. It is important to monitor asthma during pregnancy because up to 45% of women may experience an asthma exacerbation requiring medical intervention during pregnancy. Poorly controlled maternal asthma and exacerbations are associated with poor pregnancy outcomes, including low birth weight, preterm birth, and preeclampsia. Poorly controlled asthma is also associated with an increased risk of asthma in the child. Reducing the risk of exacerbations is therefore of clinical importance.

In a study published in The Journal of Allergy and Clinical Immunology: In Practice, Bokern et al. investigated patient and asthma related factors associated with severe asthma exacerbations during pregnancy. Data was obtained from 4 studies on asthma during pregnancy conducted between 2004 and 2019 across eastern Australia, including 1,461 pregnant women with asthma. The authors used the information collected at study entry (around 18 weeks gestation) to identify risk factors for exacerbations occurring during the remainder of pregnancy.

Severe asthma exacerbations involving an emergency room visit, hospital admission or course of oral corticosteroid medication were reported for 9.2% of women. The authors found that asthma exacerbations before pregnancy and more severe asthma at the beginning of pregnancy were associated with an increased risk of exacerbations during pregnancy. Use of medium to high doses of inhaled corticosteroids was most strongly associated with severe asthma exacerbations. This warrants further research and may be related to disease severity. Overall, the study suggests that asthma control and severity before and at the beginning of pregnancy may predict future exacerbations. Due to the potentially severe consequences of asthma exacerbations, it is important to optimize asthma management during pregnancy. The factors associated with asthma exacerbations during pregnancy identified by Bokern and colleagues may help healthcare professionals to identify women who are at risk and thereby implement early interventions to mitigate exacerbation risk.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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