- 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 corticiosteroids 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, M.D., M.S., chief of the Department of Allergy for Kaiser Permanente San Diego Medical Center. Schatz is also a member of the NAEPP expert panel on asthma during pregnancy and author of an editorial accompanying the guidelines report.
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.
"As important as medications are for controlling asthma, a pregnant woman can reduce how much medication is needed by identifying and avoiding the factors that make her asthma worse, such as tobacco smoke or allergens like dust mites," added Dr. Schatz.
The NAEPP was established in March 1989 to reduce asthma- related illness and death and to enhance the quality of life of people with asthma. Today, 40 organizations, including major medical associations, voluntary health organizations, and numerous federal agencies, comprise the NAEPP Coordinating Committee. The NAEPP also coordinates federal asthma-related activities, as designated by Congress through the Children's Health Act of 2000. NAEPP convenes expert panels as needed to ensure that the latest scientific evidence is translated into clinical recommendations to help clinicians provide the best possible asthma care.
For more information on the new guidelines, NAEPP, and asthma care:
- National Asthma Education and Prevention Program Expert
Panel Report: Managing Asthma During Pregnancy:
Recommendations for Pharmacologic Treatment - 2004 Update.
Quick Reference. "Journal of Allergy & Clinical
Immunology". January 2005.
- The quick reference guide, full report, and evidence
tables for the NAEPP Working Group Report on Managing
Asthma During Pregnancy: Recommendations for Pharmacologic
Treatment - 2004 Update are available at:
http://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg.h
tm
- Guidelines for the Diagnosis and Management of Asthma -
Update on Selected Topics 2002, http://www.nhlbi.nih.gov/guidelines/asthma/index.htm
- National Asthma Education and Prevention Program, http://www.nhlbi.nih.gov/about/naepp/index.htm
NHLBI is part of the National Institutes of Health (NIH), the Federal Government's primary agency for biomedical and behavioral research. NIH is a component of the U.S. Department of Health and Human Services. Additional information about asthma and other NHLBI-supported research and educational programs are available online at the NHLBI website, http://www.nhlbi.nih.gov
