Mamas on Bedrest: Manage asthma so that you can breathe deeply.

August 10th, 2011

Mamas on Bedrest, if you aren’t breathing well neither is your baby and that isn’t good for either of you.

It’s already been shown that pregnant women with asthma are at increased risk for preterm labor and for delivering low birth weight infants, especially infant girls. (see our blogpost on untreated asthma) Many women mistakenly believe that their asthma medications will  harm their babies and stop taking them. But with asthma, the risk to mama and baby’s health far outweighs the risk of taking medication to control asthma. In fact, untreated asthma can have potentially deadly effects for both.

Pregnant women with asthma can experience no change in symptoms, an improvement in symptoms or worsening of symptoms. In general, women with moderate to severe asthma are more likely to experience worsening of asthma symptoms and to experience pregnancy complications as a result.

As stated in our previous blogpost on asthma, it’s very important to monitor and to control asthma symptoms to avoid adverse outcomes for mama and her baby. There are several medications that have been found to be safe in pregnancy and we present a few of them here. If you have asthma, take this list with you and discuss with your OB or pulmonologist to create an asthma treatment plan that is best for you.

Non Medical Treatments

First and foremost, it is important to avoid triggers. Some of the most common triggers include cigarette smoke, animal dander, dust mites and cockroaches. Pregnant women should not smoke and most certainly pregnant women with asthma should not smoke. But what many women don’t realize is that second hand smoke is just as detrimental, so pregnant women, especially pregnant women with asthma should not be exposed to second hand smoke.

If a pregnant woman with asthma is allergic to animal dander, she should limit her exposure to animal dander. I tread lightly here because I had a cat while I was pregnant. I hadn’t had an attack in years but with my second pregnancy, my asthma flared. The pulmonologist suggest that I give my cat up. She was my first baby and by the time I was having my children, I had had her over 15 years. There was NO WAY I was giving her up! But I did keep her out of my bed room and though I continued to pat her, I had to cut back on our cuddling.

If dust mites are the culprit, encase mattresses and pillows in hypoallergenic cases and wash and dry bed linens in high heat. And if cockroaches are the issues, exterminate with low toxicity chemicals and by removing exposed food and garbage and using poison baits and traps in lieu of harsh chemicals.

Gastroesophageal reflux disease (GERD) can also exacerbate asthma. Patients with GERD should avoid food and drink within 3 hours of bedtime, elevate the head of the bed, and eat smaller meals.

Medical (Medicine) Treatments

The reality is that many if not most pregnant asthmatics will need medication to control their asthma during pregnancy, labor and delivery and in the early post partum. The medications fall into the following categories:

Rescue Medications

These are the short acting bronchodilators such as albuterol. When mama is experiencing acute symptoms, she should first reach for these medications for instantaneous relief. They have been proven safe in pregnancy in prescribed doses.

Maintenance Medications. These medications will help prevent the airway narrowing and inflammation that occur with asthma.

Inhaled Corticosteroids: Inhaled corticosteroids (ICSs), which help prevent and control inflammation, are the preferred controller medicine for asthmatic patients, including pregnant mamas. These medications have been shown to improve asthma symptoms and increase pulmonary function. Budesonide (Pulmicort and Rhinocort) is preferred during pregnancy because of its proven efficacy and safety in numerous studies.

Long acting Beta Agonists. Long acting beta agonists are the longer or sustained release forms of many of the rescue medications. These must be used with caution as they can cause heart and other unpleasant side effects. They are typically only used when a patient cannot use an inhaled corticosteroid or if the inhaled corticosteroid isn’t providing full symptom coverage.

Theophylline: While theophylline is not a preferred adjunctive therapy in asthma, it may be used as an alternative in patients who are not adequately controlled on ICSs alone.theophylline is used in pregnancy, a low dose is recommended, with maintenance serum concentrations of 5 mcg/mL to 12 mcg/mL. Side effects of theophylline include nausea, palpitations, and insomnia.

Cromolyn: Although cromolyn has an excellent safety profile, this agent is not preferred in pregnant patients with asthma.

Leukotriene Modifiers: Montelukast and zafirlukast (Singulaire andAcc0lade), two available leukotriene receptor antagonists (LTRAs), are not preferred therapies in asthma, but they may be used as an adjunctive alternative in persistent asthmaitor, in pregnancy.

Immunomodulator: There are no adequate, well-controlled studies regarding the use of omalizumab in pregnancy. Currently, the manufacturer recommends that the drug be used in pregnancy only if it is clearly needed.

Systemic Steroids. Mamas with severe asthma symptoms may need to take oral steroids. This is typically reserved for patients with the most severe symptoms posing a significant risk to both mama and baby. 

Most pregnant mamas with asthma will need to continue the medication into the early post partum. Many mamas will have to have additional medication during labor and delivery as asthma can exacerbate uterine contractions and in other ways affect labor and delivery.

The Take Home Message

If you are a pregnant mama with asthma, talk to your doctor about your asthma management. It is critical to your health and your baby’s health that your asthma is well managed. Don’t delay. Your lives may depend on it!

This post is a summary of the MedScape article “Optimizing Patient Care in Asthma During Pregnancy: Management: Pharmacologic Therapy”

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