Factors Associated with Asthma Exacerbations During Pregnancy

Bokern, Marleen; Robijn, Annelies L.; Jensen, Megan E.; Barker, Daniel; Callaway, Leonie K.; Clifton, Vicki L.; Wark, Peter; Giles, Warwick B.; Mattes, Joërg; Peek, Michael; Attia, John; Seeho, Sean; Abbott, Alistair; Gibson, Péter G.; Murphy, Vanessa E.

doi:10.1016/j.jaip.2021.07.055

Cited by 16 publications

(36 citation statements)

References 53 publications

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“…In some women, pregnancy has no impact on asthma, and some may even experience asthma improvement; however, some women experience asthma worsening. 10,68 Exacerbations and poor asthma control are also common in pregnancy 10,68,69 and may be due to hormonal changes, or potentially to cessation or reduction of asthma medication owing to unfounded safety concerns. 10 Smoking during pregnancy may also contribute to poor control.…”

Section: Effects Of Sex and Gender On Asthma Severity And Symptoms As...mentioning

confidence: 99%

See 1 more Smart Citation

Personalized Treatment of Asthma: The Importance of Sex and Gender Differences

Jenkins

Boulet

Lavoie

et al. 2022

The Journal of Allergy and Clinical Immunology: In Practice

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Section: Effects Of Sex and Gender On Asthma Severity And Symptoms As...mentioning

confidence: 99%

“…How do sex and gender affect asthma pathogenesis, clinical course, severity, symptoms, treatment, and management? 3,9,12,27,68,71,77,86,91,97,104,107,125,140,141,144 HCP, health care professional.…”

Section: Asthma Treatment and Managementmentioning

confidence: 99%

Personalized Treatment of Asthma: The Importance of Sex and Gender Differences

Jenkins

Boulet

Lavoie

et al. 2022

The Journal of Allergy and Clinical Immunology: In Practice

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“…83–86 Asthma tends to return to the pre-pregnancy state after delivery. 91–93 Some studies 88 , 90 , 97 , 100–106 investigated association between fetal gender and maternal asthma, but reported inconsistent results. Menopause To our best knowledge, no studies have investigated asthma progression during menopausal transition among women with asthma.…”

Section: Age- and Gender-related Disparities In Asthmamentioning

confidence: 99%

“…Several studies found that during pregnancy women with asthma carrying a female fetus were more likely than those carrying a male fetus to have greater airway lability, 100 increased steroid use, 97 , 101 or asthma exacerbations, 102 , 103 but these findings were not replicated in other studies. 88 , 90 , 104–106 …”

Section: Epidemiological Evidence On Sex Hormones and Asthma Progress...mentioning

confidence: 99%

Sex Disparities in Asthma Development and Clinical Outcomes: Implications for Treatment Strategies

Gq¹,

SS²,

Rådinger³

et al. 2022

JAA

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A gender-related disparity exists in asthma morbidity and mortality, which shifts at around puberty from a male predominance to a female predominance. This is clinically reflected in the fact that asthma that occurs in childhood (childhood-onset asthma) mainly affects boys, and that asthma that occurs in adulthood (adult-onset asthma) mainly affects women. Adult-onset asthma is often non-atopic, more severe, and associated with a poorer prognosis, thus posing a marked burden to women’s health and healthcare system. Many factors have been indicated to explain this gender-related disparity, including sociocultural and environmental factors as well as biological sex differences (genetic, pulmonary and immunological factors). It has long been suggested that sex hormones may be implicated in at least these biological sex differences. Overall, the evidence remains equivocal for the role of most sex hormones in asthma pathogenesis and clinical outcomes. Well-designed randomized clinical trials are required assessing the potential preventive or therapeutic effects of hormonal contraceptives on asthma in women, thereby helping to advance the evidence to inform future practice guidelines. The mechanisms underlying the role of sex hormones in asthma are complex, and our understanding is not yet complete. Additional mechanistic studies elucidating sex hormone signaling pathways and their interactions involved in the pathogenesis and clinical manifestations of asthma will help to identify potential sex hormone-driven asthma endotypes and novel therapeutic targets, providing the basis for a more personalized asthma management strategy.

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“…However, findings from both case-control [59] and randomised controlled [60] studies suggest that close monitoring during pregnancy, and by that improved asthma control, is associated with a risk for adverse outcomes very close to that in non-asthmatic women. No previous history of asthma exacerbations and stable asthma early in pregnancy are associated with a low risk of asthma exacerbation during pregnancy [61,62], whereas being prescribed moderate-to high-dose ICS is associated with a higher risk [61].…”

Section: Asthma Monitoringmentioning

confidence: 99%

Challenges in the successful management of asthma during conception, pregnancy and delivery

Gade

Tidemandsen

Hansen

et al. 2022

Breathe

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Asthma and infertility are the most common disorders among women of reproductive age. Time to pregnancy is prolonged in women with asthma, and importantly, age seems to be a more important risk factor regarding fertility in women with asthma compared to women without asthma. Some data have shown a higher frequency of miscarriages in women with asthma, although the data are conflicting on this issue as studies have observed no association between asthma and pregnancy loss. Furthermore, studies have shown no negative effect of asthma on the total number of offspring. Pregnancy may, thus, have a significant impact on women with asthma, as well as on their offspring.The age of the women has an important impact on ability to conceive, but also for the pregnancy itself, with higher risk of uncontrolled asthma as well as asthma exacerbations with increasing age. Well-controlled asthma decreases the risk of maternal and fetal complications, while poorly controlled and undertreated asthma is associated with a range of risks for both mother and fetus. Asthma treatment should follow the general guidelines for asthma therapy, irrespective of pregnancy status, including treatment with inhaled corticosteroids, β2-agonists and muscarinic antagonists. Targeted treatment with biologics for severe asthma seems to be without important adverse effects. The use of systemic corticosteroids may be associated with adverse events during the first trimester; however, an exacerbation with the associated risk of hypoxaemia is worse for the fetus. Best possible asthma control may be achieved using repeated measurements of fractional exhaled nitric oxide (FENO), as the use of FENO compared with symptoms registration only has been shown to reduce exacerbation rate.In conclusion, women with asthma should be encouraged to conceive at an early age, might experience miscarriages, but the number of offspring are the same as in women without asthma. Well treated asthma is important for the well-being of both the mother and the unborn fetus.

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Factors Associated with Asthma Exacerbations During Pregnancy

Cited by 16 publications

References 53 publications

Personalized Treatment of Asthma: The Importance of Sex and Gender Differences

Personalized Treatment of Asthma: The Importance of Sex and Gender Differences

Sex Disparities in Asthma Development and Clinical Outcomes: Implications for Treatment Strategies

Challenges in the successful management of asthma during conception, pregnancy and delivery

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