Managing asthma in pregnancy

Abstract

Asthma is a common comorbidity during pregnancy and its prevalence is increasing in the community. Exacerbations are a major clinical problem during pregnancy with up to 45% of women needing to seek medical help, resulting in poor outcomes for mothers and their babies, including low birth weight and preterm delivery. The goals of effective asthma management in pregnancy are to maintain the best possible asthma control and prevent exacerbations. This is achieved by aiming to prevent day- and night-time symptoms, and maintain lung function and normal activity. In addition, maintaining fetal oxygenation is an important consideration in pregnancy. Guidelines recommend providing asthma advice and review prior to conception, and managing asthma actively during pregnancy, with regular 4-weekly review, provision of a written action plan, use of preventer medications as indicated for other adults with asthma, and management of comorbid conditions such as rhinitis.Improvements have been made in recent years in emergency department management of asthma in pregnancy, and multidisciplinary approaches are being proposed to optimise both asthma outcomes and perinatal outcomes. One strategy that has demonstrated success in reducing exacerbations in pregnancy is treatment adjustment using a marker of eosinophilic lung inflammation, the exhaled nitric oxide fraction (FeNO). The use of an algorithm that adjusted inhaled corticosteroids (ICS) according to FeNO and added long-acting β-agonists when symptoms remained uncontrolled resulted in fewer exacerbations, more women on ICS but at lower mean doses, and improved infant respiratory health at 12 months of age. Further evidence is needed to determine whether this strategy can also improve perinatal outcomes and be successfully translated into clinical practice.Key pointsAsthma is the most common chronic disease to affect pregnant women.Exacerbations occur in up to 45% of pregnant women with asthma.Asthma should be managed during pregnancy as for other adults.Treatment adjustment using a marker of airway inflammation reduces the exacerbation rate in pregnancy.Educational aimsTo identify the goals of and steps associated with effective asthma management in pregnancy.To understand the maternal and perinatal risks associated with asthma during pregnancy.To describe a management strategy that has been shown to reduce exacerbations in pregnant women with asthma.

Characteristics of health behaviours and health status indicators among pregnant women in Slovenia

“…Furthermore, some pre-existing chronic diseases are known to worsen during pregnancy. Studies found that the rate of hospitalizations for asthma is higher among pregnant women than non-pregnant women, after adjusting for age and exacerbation history (34,35). It is also recognised that even women with mild asthma are at increased risk of severe exacerbation during pregnancy (34).…”

Bronchial Asthma in Pregnancy

“…The asthma medications are safe during pregnancy and are FDA pregnancy category B and C. Upto 45% of females get moderate to severe asthma exacerbation during pregnancy [2]. Exacerbations are more severe and more frequent in patients with uncontrolled or partially controlled asthma.…”

“…Exacerbations are more severe and more frequent in patients with uncontrolled or partially controlled asthma. Pregnant females have higher chances (1.3%) of requiring hospitalization for asthma exacerbation than non-pregnant females (0.8%) [2]. Bronchial asthma exacerbation increases the risk of perinatal complications with females with moderate to severe asthma having increased risk of preterm delivery (RR -1.54) and Low birth weight (RR -3.02) [4,5].…”

“…There is ample published data that shows that patients with asthma are undertreated during pregnancy even if they were on adequate medications prior to conception. Among women who report having asthma prior to conception only 63% to 76% were on asthma medications during their pregnancy [2]. This change in medication pattern can be explained by change in disease severity during pregnancy with 45% of females experiencing worsening of symptoms and upto one third of females reporting improvement in their asthma symptoms [2,3].…”

“…Among women who report having asthma prior to conception only 63% to 76% were on asthma medications during their pregnancy [2]. This change in medication pattern can be explained by change in disease severity during pregnancy with 45% of females experiencing worsening of symptoms and upto one third of females reporting improvement in their asthma symptoms [2,3]. One important factor is physician concern for safety of medications and lack of awareness of guidelines.…”