New treatment guidelines for pregnant women with asthma


The National Asthma Education and Prevention Program (NAEPP) has issued the first new guidelines for managing asthma during pregnancy.
The report reflects new medications that have emerged and updates treatment recommendations for pregnant women with asthma based on a systematic review of data on the safety of asthma medications during pregnancy.

Asthma affects over 20 million Americans and is one of the most common potentially serious medical conditions to complicate pregnancy. Maternal asthma is associated with increased risk of infant death, preeclampsia ( a serious condition marked by high blood pressure, which can cause seizures in the mother or fetus ), premature birth, and low-birth weight. These risks are linked to asthma severity — more severe asthma increases risk, while better controlled asthma is tied to decreased risks.

Asthma worsens in approximately 30 percent of women who have mild asthma at the beginning of their pregnancy, according to a study by the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network and cofunded by NHLBI. The study also found that, conversely, asthma improved in 23 percent of the women who initially had moderate or severe asthma.

“ We cannot predict who will worsen during pregnancy, so the new guidelines recommend that pregnant patients with persistent asthma have their asthma checked at least monthly by a healthcare provider, ” explained Mitchell Dombrowski, of St. John Hospital in Detroit, and a member of the NAEPP expert panel.

Key recommendations from the guidelines regarding medications include:

Albuterol, a short-acting inhaled beta2-agonist, should be used as a quick-relief medication to treat asthma symptoms. Pregnant women with asthma should have this medication available at all times.

Women who have symptoms at least two days a week or two nights a month have persistent asthma and need daily medication for long-term care of their asthma and to prevent exacerbations. Inhaled corticosteroids are the preferred medication to control the underlying inflammation in pregnant women with persistent asthma.
The guidelines note that there are more data on the safety of Budesonide use during pregnancy than on other inhaled corticosteroids; however, there are no data indicating that other inhaled corticosteroids are unsafe during pregnancy, and other inhaled corticosteroids may be continued if they effectively control a patient’s asthma.
Alternative daily medications are leukotriene receptor antagonists, Cromolyn, or Theophylline.

For patients whose persistent asthma is not well controlled on low doses of inhaled corticosteroids alone, the guidelines recommend either increasing the dose of inhaled corticosteroid or adding another medication — a long-acting beta agonist. The expert panel concluded that data are insufficient to indicate a preference of one option over the other.

Oral corticosteroids may be required for the treatment of severe asthma. The guidelines note that there are conflicting data regarding the safety of oral corticosteroids during pregnancy; however, severe, uncontrolled asthma poses a definite risk to the mother and fetus; and use of oral corticosteroids may be warranted.

“ Several studies have shown that taking inhaled corticosteroids improves lung function during pregnancy and reduces asthma exacerbations — and other large, prospective studies found no relation between taking inhaled corticosteroids and congenital abnormalities or other adverse pregnancy outcomes,” said Michael Schatz, chief of the of Kaiser Permanente San Diego Medical Center. Schatz is also a member of the NAEPP expert panel on asthma during pregnancy.

The guidelines highlight other important aspects of asthma management during pregnancy, such as identifying and limiting exposure to asthma triggers.
Similarly, women with other conditions that can worsen asthma, such as allergic rhinitis, sinusitis, and gastroesophageal reflux, should have those conditions treated as well. Such conditions often become more troublesome during pregnancy.

Source: NIH, 2005

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