Recent Advances in Patient Treatment and Care (Track)



Management of Asthma in Pregnancy

Charlotte Suppli Ulrik
Dept. of Respiratory Diseases Hvidovre University

Abstract:

Asthma is the most prevalent condition to complicate pregnancy, and observational studies have revealed a strong association between poor asthma control during pregnancy and complications of pregnancy, including preterm birth and perinatal death. Furthermore, pregnancy may also have significant impact on the course of asthma, as the severity may improve, worsen or remain unchanged during pregnancy.
 
The level of asthma control should be assessed on the basis of symptoms, use of rescue medication, and spirometry at least every 4 weeks in women who require controller therapy during pregnancy.

All patients should receive education regarding the relationship between asthma and pregnancy, inhaler technique, importance of adherence with controller therapy, control of environmental triggers, and signs of worsening asthma control.

Although data on adverse effects of asthma medication in pregnancy is, for obvious reasons, observational, most of the available observations are reassuring, as no increased risks, including preeclampsia, low birth weight and congenital malformations, have been associated with the use of inhaled β2-agonists and inhaled corticosteroids. Data on the use of leukotriene modifiers during pregnancy are more limited.

As in the non-pregnant patient, treatment of the pregnant patient with asthma should be guided by the current level of asthma control, and the overall goal is best possible control. All patients with a need for rescue medication more than once a week, impaired lung function and/or previous exacerbations should be treated with inhaled corticosteroids. If control is not achieved on low-dose inhaled corticosteroids, therapy should be stepped-up to medium dose inhaled corticosteroids. Next step is add-on long-acting β2-agonist, and, if necessary, high-hose inhaled corticosteroid plus long-acting β2 should be considered. Non-pharmacological reasons for suboptimal effect of treatment should always be considered before stepping-up therapy. In general, it is not recommended to step-down therapy during pregnancy due to the potential risk of loss of control.