The National Asthma Education and Prevention Program (NAEPP) issued new guidelines for managing asthma during pregnancy – they are the first new guidelines in more than ten years. Unmanaged asthma in pregnant women can lead to serious complications for mother and fetus.

The guidelines recommend stepping up medication when asthma is serious and stepping it down when asthma is less severe. Pregnant women should consult with their obstetricians to get proper treatment.

Unborn children experience trouble breathing when their mothers do. A recent study by the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network and cofunded by NHLBI found that pregnant women with mild asthma experienced worsening asthma approximately 30 percent of the time. Conversely, 23 percent of the pregnant women with moderate or severe asthma studied experienced improvement.

The new guidelines offered the following recommendations:

• Using Albuterol, a short-acting inhaled beta2-agonist, for fast relief of asthma symptoms. The medication should be kept available to pregnant women with asthma at all times.
• Pregnant women with asthma symptoms at least two nights a month or two days a week need to use daily inhaled corticosteroid medication – no studies have found that this medication is unsafe during pregnancy. Other medications pregnant women may need to use include cromolyn, theophylline or leukotriene receoptor antagonists.
• If asthma symptoms are not controlled well with the above medications, increased doses should be used or a long-acting beta agonist medication added.
• Severe asthma may require the use of oral corticosteroids.

Other important considerations for pregnant women with asthma include:

• Asthma triggers should be identified and exposure to them should be limited.
• Pregnant women with conditions such as sinusitis, allergic rhinitis and gastroesophageal reflux should be treated for those conditions.
• Dust mites should be controlled, and exposure to asthma producing factors such as tobacco smoke should be avoided.

Lung function is improved during pregnancy when inhaled corticosteroids are used, and these medications have not been found to cause congenital abnormalities or other adverse pregnancy outcomes, according to Michael Schatz, M.D., M.S., chief of the Department of Allergy for Kaiser Permanente San Diego Medical Center. Schatz authored an editorial that accompanied the guidelines.

By Ellie Kuykendall