Asthma medication use during pregnancy, wheeze and estimated exposure to ambient nitrogen dioxide

Gent, Janneane F.; Kezik, Julie M.; Hill, Melissa E.; McKay, Lisa A.; Holford, Theodore R.; Leaderer, Brian P.; Bracken, Michael B.

doi:10.1183/09031936.00161514

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…42 Women who reduce their asthma medication use during pregnancy are twice as likely to experience increased days of wheeze (OR, 2.17), particularly in areas of high nitrogen dioxide air pollution and in warm months. 43 Enrollment in an asthma management program with monthly visits increased asthma control and medication adherence, measured according to a prescription fill rate, from 28% to 46%, although the same women self-reported adherence rates of up to 73%. 44 In terms of counseling regarding medication safety, it should be noted that the US Food and Drug Administration has updated its pregnancy and lactation labeling guidelines.…”

Section: Medication Discontinuation and Safetymentioning

confidence: 98%

Asthma Outcomes and Management During Pregnancy

Bonham

Patterson

Strek

2018

Chest

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Asthma during pregnancy poses a common, increasingly prevalent threat to the health of women and their children. The present article reviews recent insights gained from the epidemiology of asthma during pregnancy, demonstrating the many short- and long-term risks to mother and fetus incurred by poorly controlled maternal asthma. We further discuss emerging evidence that active management of asthma during pregnancy can positively influence and perhaps completely mitigate these poor outcomes. Recent high-quality trials examining best methods for asthma treatment are reviewed and synthesized to offer an evidence-based pathway for comprehensive treatment of asthma in the outpatient setting. Safe and effective medications, as well as nonpharmacologic interventions, for asthma during pregnancy are discussed, and treatment options for related conditions of pregnancy, including depression, rhinitis, and gastroesophageal reflux, are presented. Throughout, we emphasize that an effective treatment strategy relies on a detailed patient evaluation, patient education, objective measurement of asthma control, and frequent and supportive follow-up. The cardiovascular and respiratory physiology of pregnancy is reviewed, as well as its implications for the management of patients with asthma, including patients requiring intubation and mechanical ventilation. For the situation when outpatient asthma management has failed, an approach to the critically ill pregnant patient with status asthmaticus is detailed. Multidisciplinary teams that include pulmonary specialists, obstetricians, primary care providers, nurses, pharmacists, and asthma educators improve the care of pregnant women with asthma.

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Section: Medication Discontinuation and Safetymentioning

confidence: 98%

Asthma Outcomes and Management During Pregnancy

Bonham

Patterson

Strek

2018

Chest

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“…38 Another study from the United States described the relationships between wheeze in each month of gestation, residential nitrogen dioxide (NO 2 ) exposure, and the use of asthma medications. 39 In women exposed to NO 2 levels > 16 parts per billion (ppb), wheezing for more than 7 days/month was more likely in those who reduced their asthma maintenance therapy in pregnancy compared with those who maintained or increased their medication use. 39 Even women who maintained their asthma medication use in pregnancy were at increased risk of wheeze with a 5 ppb increase in NO 2 exposure (OR: 1.68, 95% CI: 1.25-2.26) during warm months; however, the increased risk for women who reduced their asthma medication use in pregnancy was further elevated (OR: 2.57, 95% CI: 1.73-3.81), and there was a statistically significant increased risk of wheeze even in cool months.…”

Section: Adverse Perinatal Outcomes Associated With Asthma Exacerbatimentioning

confidence: 99%

“…39 Even women who maintained their asthma medication use in pregnancy were at increased risk of wheeze with a 5 ppb increase in NO 2 exposure (OR: 1.68, 95% CI: 1.25-2.26) during warm months; however, the increased risk for women who reduced their asthma medication use in pregnancy was further elevated (OR: 2.57, 95% CI: 1.73-3.81), and there was a statistically significant increased risk of wheeze even in cool months. 39 More research into the influence of air pollution as a trigger for asthma during pregnancy is warranted.…”

Section: Adverse Perinatal Outcomes Associated With Asthma Exacerbatimentioning

confidence: 99%

Asthma during Pregnancy: Exacerbations, Management, and Health Outcomes for Mother and Infant

Murphy

Jensen

Gibson

2017

Semin Respir Crit Care Med

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One in 10 pregnant women worldwide has asthma and of these, 10% will have a severe exacerbation requiring oral corticosteroids (OCSs) in pregnancy. This review of recent publications in the field will describe the effects of exacerbation on maternal and neonatal health, the use of asthma medications during pregnancy, and will suggest novel management approaches for asthma in pregnancy. Pregnancy results in unpredictable changes in the disease; therefore, regular monitoring of symptoms is recommended. Uncontrolled asthma is frequently described in cohorts of pregnant women with asthma, and some recent studies show associations with adverse perinatal outcomes, as previously demonstrated with exacerbations. Guidelines for the management of asthma recommend the continued use of inhaled corticosteroids (ICSs) in pregnancy, with budesonide having a particularly good safety profile. Recent data suggest small effects of asthma and/or asthma medication use on congenital malformations; however, there is less data available on the safety of ICS/long-acting β agonist combinations, which are increasingly used for maintenance treatment. Novel management strategies are needed to address the complex needs of pregnant women with asthma. These include medication nonadherence and the presence of numerous comorbidities which can affect asthma, such as rhinitis, cigarette smoking, obesity, and mental health issues. Inflammation-based management has been shown to be effective in reducing exacerbations in pregnancy and may also improve perinatal outcomes. The involvement of a multidisciplinary team and the assessment of comorbidities have potential to improve the health of mothers and their offspring.

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