Ages & Stages Pregnancy: Managing Asthma During Pregnancy

During pregnancy, a woman’s asthma symptoms can worsen, improve or remain the same. It is extremely important for a pregnant woman with asthma to manage her asthma for her health and her baby’s health. Uncontrolled asthma can be a threat to maternal well-being, as well as to fetal growth and survival.

For the 30 percent of 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 crises are usually neither more frequent, nor more severe.

Uncontrolled asthma causes a decrease in the amount of oxygen in the mother’s blood. Decreased oxygen in her blood can lead to decreased oxygen in the fetal blood. A fetus requires a constant supply of oxygen for normal growth and development. Decreased oxygen can lead to impaired fetal growth and survival.
Studies show, however, maternal asthma that is well managed during pregnancy does not increase the risk of maternal or infant complications.

Frequently, asthma and allergies are undertreated by both physicians and patients during pregnancy. This may be due to the fear of adverse effects medication might have on the fetus.

Asthma Medications
Asthma management and treatment goals during pregnancy are the same as for other patients — to prevent hospitalization, emergency room visits, work loss and chronic disability. Even though a woman might feel uneasy taking medications, the risks of uncontrolled asthma appear to be greater than the risks of necessary asthma medications. Prior to pregnancy, a woman should visit her allergist/immunologist to discuss the use of medication during the anticipated pregnancy.

Inhaled corticosteroids are the preferred choice of medication for the treatment of 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. Women should visit their allergist/immunologist to receive proper treatment during pregnancy.

The National Asthma Education Prevention Program (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.

Asthma Management
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.

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 such as dust mites, pollens and indoor molds; and irritants such as tobacco smoke, wood-burning stoves or fireplaces, perfumes, cleaning agents or 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.

Asthma Control
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 allergist/immunologist about how to properly manage these conditions.

When to See a Specialist
If a woman has asthma and thinks she is pregnant, or is pregnant, it’s important for her to consult with an allergist/immunologist. Managing asthma and avoiding asthma flare-ups during pregnancy is important to the health of the mother and fetus. It is best if women see their allergist/immunologist regularly during pregnancy so that any worsening of asthma can be countered by appropriate changes in the management program.

The American Academy of Allergy, Asthma & Immunology’s How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provides information to assist patients and health-care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:
• have moderate-severe or uncontrolled asthma.
• have a history of severe asthma flare-ups.
• have a family history of allergies and are interested in identifying prevention strategies for their infant.

Reprinted with permission from www.aaaai.org, the Web site of the American Academy of Allergy, Asthma & Immunology.