Management of Asthma in Pregnancy

Abstract

Asthma is currently considered to be a disorder with many inflammatory characteristics. Effective control of asthma is imperative to avoid the adverse effects of maternal hypoxaemia, hypocarbia or hypercarbia, with a reduction of fetal oxygenation. Medications considered appropriate for use throughout gestation include the combination of inhaled beclomethasone dipropionate and terbutaline, which can be sufficient for many pregnant women. Overuse of β-agonists must be avoided during gestation, as unappreciated maternal hypoxaemia with fetal distress may occur. Sodium cromoglycate (cromolyn sodium) is appropriate for mild asthma, and can be used prophylactically before animal exposure or exercise. Theophylline is appropriate, but its role is diminishing. A short course of oral prednisone can help prevent the need for emergency therapy if regular medications are not adequate and severe coughing or wheezing has occurred. Data on safety during pregnancy are not available for nedocromil sodium, another anti-inflammatory medication. There is now evidence that avoidance of status asthmaticus is associated with nearly normal pregnancy outcomes, even in women with severe asthma.