Effect of Pregnancy on Airway Responsiveness and Asthma Severity: Relationship to Serum Progesterone

Juniper, E. F.; Daniel, E. E.; Roberts, Robin S.; Kline, Patricia A.; Hargreave, F. E.; Newhouse, Michael T.

doi:10.1164/ajrccm/143.3_pt_2.s78

Cited by 19 publications

(12 citation statements)

References 2 publications

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“…Even though asthma symptoms exacerbations in humans have been linked to hormonal status in females [11][12][13][14][15], airway hyperresponsiveness in estrogen receptor-a knockout mice augments, while it diminishes in mice treated with E 2 [16][17][18]. Because AEs are structurally related to E 2 , we expected them to have a protective effect on the airways, nevertheless our findings showed opposite results.…”

Section: Discussionmentioning

confidence: 62%

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17β-Aminoestrogens induce guinea pig airway smooth muscle hyperresponsiveness through L-type Ca 2+ channels activation

et al. 2015

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Section: Discussionmentioning

confidence: 62%

“…Furthermore, asthma exacerbations in women are related to life period and its severity to their hormonal status, i.e., puberty, menstrual cycle, pregnancy and menopause [11][12][13][14][15]. Thus, all these evidences point out the role of female sex steroids in airway smooth muscle reactivity.…”

Section: Introductionmentioning

confidence: 99%

17β-Aminoestrogens induce guinea pig airway smooth muscle hyperresponsiveness through L-type Ca 2+ channels activation

et al. 2015

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“…When individual data was examined, 11 subjects improved and five worsened during pregnancy and there was no relationship between airway responsiveness and serum progesterone or oestriol concentrations [105,110].…”

Section: The Effect Of Pregnancy On Asthmamentioning

confidence: 99%

Asthma during pregnancy: mechanisms and treatment implications

Murphy

Gibson²,

Smith³

et al. 2005

Eur Respir J

159

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Asthma is becoming increasingly prevalent worldwide. Numerous historical and prospective cohort studies have investigated the effects of maternal asthma on pregnancy outcome; however, the data has been conflicting and many studies have not used standard classifications for asthma severity. Overall, the literature suggests that asthmatic females are more at risk of low birth weight neonates, pre-term delivery and complications such as preeclampsia, especially in the absence of actively managed asthma treated with inhaled corticosteroids. Pregnancy with a female foetus may particularly increase the risk of these outcomes.In addition, pregnancy has an effect on the course of asthma. The risk of an exacerbation requiring medical intervention may be as high as 50% in females with severe asthma and this may further increase the risk of poor outcomes, particularly low birth weight and pre-term delivery.The mechanisms responsible for changes in asthma with pregnancy, or alterations in pregnancy outcomes due to asthma have not been thoroughly explored. Maternal inflammatory pathways may contribute to reduced foetal growth through alterations in placental function.Asthma treatment, by reducing maternal inflammation and preventing exacerbations, is safe for use in pregnant females and contributes to improved outcomes for both mother and foetus.

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“…Exacerbations were lower in the daily ICS (28%, 18–40, p=0.03), combined (31%, 21–43, p=0.07), and rescue (35%, 24–47, p=0.07) groups compared to placebo (49%)(9). Treatment failure occurred in 23% (95% CI 14–43) of the placebo group, compared with 5.6% (1.6–14) in the combined (p=0.012), 2.8% (0–10) daily (p=0.009), and 8.5% (2–15) in the rescue (p=0.024) groups. Overall daily therapy had the best outcomes but rescue therapy was better than placebo and may reflect real world patient behavior (30).…”

Section: Can Daily Low Dose Ics Be Reduced or Stopped In Mild To Modementioning

confidence: 99%

“…However, patients and some providers still have doubts about ICS safety, leading to the desire to reduce or stop these medications (13, 14). When mild asthma is controlled, ICS can often be reduced by 50%, but reducing therapy is less successful with rapid medication tapering and in moderate to severe disease (15–18). Roughly 50% of children and adults will redevelop symptoms within 1–12 months if ICS is stopped.…”

Section: Can Daily Low Dose Ics Be Reduced or Stopped In Mild To Modementioning

confidence: 99%

Stepping down asthma treatment

Rogers

Reibman

2012

Current Opinion in Pulmonary Medicine

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Purpose of Review Guidelines suggest that asthma medication should be reduced once asthma control is sustained. Moderate dose inhaled corticosteroids (ICS) can typically be reduced, but questions remain about the lowest effective ICS dose and the role of non-ICS controllers in treatment reduction. Long acting beta agonist (LABA) safety concerns have created controversy about how to step down patients on ICS/LABA therapy. This review will focus on the current status of these issues. Recent findings Intermittent ICS treatment, often in fixed combination with short-acting beta agonist, is an emerging strategy for control of mild asthma. Addition of leukotriene modifiers, LABAs, and omalizumab to ICS can allow for reduced ICS dosing. Doses of ICS that control symptoms may be inadequate to control exacerbations. Reducing ICS dose before discontinuing LABAs may be the more effective approach for patients on combination therapy. Summary Use of non-ICS controllers allow for ICS dose reduction with superior outcomes. Tapering of ICS prior to LABA discontinuation may be the favored approach for patients on ICS/LABA therapy, but an understanding of long-term outcomes and further safety data are required. The lowest ICS dose that adequately controls both asthma impairment and risk remains to be determined.

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Effect of Pregnancy on Airway Responsiveness and Asthma Severity: Relationship to Serum Progesterone

Cited by 19 publications

References 2 publications

17β-Aminoestrogens induce guinea pig airway smooth muscle hyperresponsiveness through L-type Ca 2+ channels activation

17β-Aminoestrogens induce guinea pig airway smooth muscle hyperresponsiveness through L-type Ca 2+ channels activation

Asthma during pregnancy: mechanisms and treatment implications

Stepping down asthma treatment

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