Asthma and pregnancy: interactions and management

Abstract

Key pointsAsthma is one of the most common diseases complicating pregnancy.Pregnancy influences the control of asthma; its effect may be beneficial or detrimental.Asthma during pregnancy should be treated according to its severity in a step-wise manner and as aggressively as asthma in nonpregnant patients.It is safer for pregnant women with asthma to be treated with asthma medications than to have asthma symptoms and exacerbations.Uncontrolled and severe asthma is associated with adverse pregnancy outcomes for both mother and foetus.Frequent monitoring, severity-based pharmacotherapy, and prevention and prompt treatment of exacerbations are very important for the safe delivery of a healthy baby.Breastfeeding is strongly recommended for asthmatic females; it is associated with a reduction in the development of atopy in children, and the use of asthma medications is safe during breastfeeding.Integrated care (obstetrics and pulmonary), patient education, compliance with treatment and avoidance of triggering factors are key issues in the management of a pregnant asthmatic patient.Educational aimsTo describe interactions between asthma and pregnancy.To present management guidelines and discuss the use of specific asthma medications during pregnancy.SummaryAsthma is one of the most common diseases complicating pregnancy. It can lead to significant morbidity for both mother and foetus. Pregnancy may also affect asthma control and severity. Therefore, pregnant asthmatic patients should receive integrated obstetric and respiratory care.The focus of asthma treatment remains the control of symptoms and maintenance of normal lung function of the mother. However, during pregnancy, the safe delivery of a healthy baby is an additional goal. It is safer for pregnant women with asthma to be treated with asthma medications than for them to have asthma symptoms and exacerbations.Asthma treatment during pregnancy follows the same step-wise approach as normal, and studies have shown that first-line asthma medications (such as inhaled glucocorticosteroids and ß2-agonists) are not associated with an increased incidence of foetal abnormalities. Moreover, inhaled glucocorticosteroids have been shown to prevent exacerbations of asthma in pregnancy and should be used in persistent asthma to control the disease and prevent exacerbations. If acute exacerbations develop, they should be treated promptly and aggressively in order to avoid foetal hypoxia.Good pregnancy and asthma outcomes are achieved through integrated obstetric and respiratory care, close monitoring, meticulous tailoring of pharmacotherapy, patient education and reassurance. This review describes interactions between asthma and pregnancy and briefly presents treatment guidelines.

Successful and safe treatment of severe steroid depended eosinophilic asthma with mepolizumab in a woman during pregnancy

“…It is therefore vital to achieve good asthma control during pregnancy. Most available asthma medications have a safety profile that has been established by numerous observational studies and the advantages of treating asthma in pregnancy far outweigh any potential risks from treatment [ 4 ].…”

“…In the United States, 5%–8% of pregnant women have asthma and worldwide up to 13% of pregnancies may be complicated by asthma [ [1] , [2] , [3] ]. Maternal asthma, especially when severe, is associated with an increased risk of adverse perinatal outcomes, therefore changes in the course of the disease are to be expected and can be unpredictable during pregnancy [ 4 , 5 ]. Optimizing asthma management in pregnancy is paramount for protecting the health of both mother and baby.…”

“…Studies examining the effect of first-line controller asthma medications have not shown risks induced to the fetus [ 4 ]. Whether newer medications for severe asthma, such as biologics, have any effect on the pregnancy and conditions of the fetus is the subject of observational studies.…”

Manajemen Asma dalam Kehamilan: Apa yang Harus Dipahami oleh Dokter Umum

“…Pasien juga dapat dipertimbangkan untuk diberikan corticosteroid sistemik berupa injeksi methylprednisolone 40-50 mg untuk memodulasi sistem imun dan diketahui aman (Gambar 2 dan Tabel 5). 43 Methylprednisolone tidak melewati sawar plasenta; berbeda dari dexamethasone, betamethasone, dan hydrocortisone. 45 Methylprednisolone tidak terbukti mampu menginduksi pematangan paru pada model janin hewan dan diketahui tidak mengubah sistem transfer plasenta.…”

“…55 Dalam kasus sulit, alih-alih sebagai pengganti, terbutaline dapat sebagai terapi tambahan jika eksaserbasi belum tercapai. 54 Terbutaline adalah obat dengan kategori B FDA, 43 golongan beta-agonis yang merangsang CONTINUING MEDICAL EDUCATION reseptor β2 bronkus lebih besar daripada reseptor β1 di jantung, sehingga dapat digunakan untuk asma. 55 Terbutaline subkutan menghasilkan perbaikan klinis setara epinephrine.…”