Systematic Review of the Safety of Regular Preventive Asthma Medications During Pregnancy

Lim, Alan T.; Stewart, Kay; König, Kai; George, Johnson

doi:10.1345/aph.1p764

Cited by 65 publications

(56 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The National Heart, Lung, and Blood Institute and the Global Initiative for Asthma (GINA) guidelines indicate that pregnant women should maintain their current regiment of asthma medications, including inhaled corticosteroids, long-acting beta agonist, leukotriene modifiers, theophylline, and oral corticosteroids (36, 37). Maintaining asthma control during pregnancy is important as severe asthma, poorly controlled asthma, and asthma exacerbations during pregnancy are associated with increased risk for development of pre-eclampsia and gestational diabetes in the mother and pre-term birth, low birth weight, and perinatal mortality for the baby (36, 38, 39). Future longitudinal studies are needed to track women with asthma prior to pregnancy and throughout the pregnancy to determine if any biomarker or clinical lung function test can be used to predict if asthma symptoms will change during pregnancy.…”

Section: Pregnancy and Asthmamentioning

confidence: 99%

Mechanisms Driving Gender Differences in Asthma

Fuseini

Newcomb

2017

Curr Allergy Asthma Rep

334

226

View full text Add to dashboard Cite

Purpose of Review Many phenotypes of asthma exist, ranging from mild asthma with onset during childhood to severe asthma with later onset, making asthma a broad disease with different pathologies. A gender disparity exists in asthma prevalence. As adults, women have an increased asthma prevalence compared to men. Further, women are more likely to have severe asthma and a later onset of asthma compared to men. Here, we review clinical and animal studies that have defined the role of sex hormones in airway inflammation, smooth muscle contraction, mucus production, and airway mechanics associated with asthma pathogenesis. Recent Findings Clinical evidence shows that increased asthma symptoms occur in females starting at puberty compared to boys. However, after puberty, the role for sex hormones in regulating asthma symptoms during menstruation, pregnancy, and menopause is not as clear. Animal studies have shown that estrogen increases and testosterone decreases Th2-mediated airway inflammation, and that females have increased IL-17A-mediated airway inflammation compared to males. Further, females had increased DC and Mφ function compared to males. However, the mechanisms driving the types of allergic inflammation are not fully elucidated. Summary Overall, ovarian hormones increased and testosterone decreased airway inflammation in asthma, but the mechanisms remain unclear. Delineating these pathways using animal models as well as women and men with various phenotypes of asthma will help determine if women with asthma should take (or avoid) hormonal contraceptives as well as predict changes asthma symptoms during life phases, including pregnancy and menopause, when sex hormones are dramatically changing.

show abstract

Section: Pregnancy and Asthmamentioning

confidence: 99%

Mechanisms Driving Gender Differences in Asthma

Fuseini

Newcomb

2017

Curr Allergy Asthma Rep

334

226

View full text Add to dashboard Cite

show abstract

“…ICSs prevent asthma exacerbations during pregnancy [124] and cessation of ICS during pregnancy is a risk factor for exacerbations (evidence A) [122]. In addition, the use of ICSs as well as β 2 -agonists or montelukast does not increase the risk for fetal abnormalities [125]. Acute exacerbations occurring during pregnancy should be treated aggressively with SABA, oxygen and systemic corticosteroids in order to avoid fetal hypoxia.…”

Section: Pregnancymentioning

confidence: 99%

Diagnosis and Management of Asthma – The Swiss Guidelines

et al. 2018

View full text Add to dashboard Cite

The Global Initiative for Asthma (GINA) is a network of individuals, organizations, and public health officials that was established to disseminate information about the care of patients with asthma and to improve asthma care. The GINA (“Global Strategy for Asthma Management and Prevention”) report has been updated annually since 2002. Due to new knowledge and therapeutic development in the field, the Swiss Respiratory Society felt the need to provide a new document that is based on both the available literature and the recommendations of the 2016 GINA report. Key new features of the 2016 GINA report include a “new” definition of asthma, underscoring its heterogeneous nature, and the core elements of variable symptoms and variable expiratory airflow limitation; the importance of confirming the diagnosis of asthma in order to minimize both under- and overtreatment; practical tools for the assessment of symptom control and risk factors for adverse outcomes; a comprehensive approach to asthma management that acknowledges the foundational role of inhaled corticosteroid therapy, but also provides a framework for individualizing patient care; an emphasis on maximizing the benefit of available medications by addressing common problems such as incorrect inhaler technique and poor adherence; a continuum of care for worsening asthma, starting with early self-management and progressing to primary care or acute care management; and diagnosis of the asthma/chronic obstructive pulmonary disease overlap syndrome. This document is meant to advice the key stakeholders on the diagnosis and management of asthma and highlights the need to individualize the care of each and every asthmatic patient.

show abstract

“…Several studies including a meta-analysis on inhaled corticosteroids have not found an increased risk for congenital malformations (Greenberger and Patterson 1983;Rahimi et al 2006;Källén and Otterblad 2007;Choi et al 2007;Lim et al 2011). No adverse fetal outcomes such as pregnancy-induced hypertension, preterm delivery or low birth weight were documented (Rahimi et al 2006;Lim et al 2011).…”

Section: Corticosteroids (Inhaled)mentioning

confidence: 99%