Pregnancy and asthma

Well-controlled asthma is rarely affected adversely by pregnancy. Some women deteriorate, some improve, and some stay unchanged. Good asthma management should cope with any exacerbation.

• Some breathlessness related to the baby’s size at the end of pregnancy is common. Except in the most severe cases, asthma is no bar to a normal delivery and caesarean section should be no more common than in the non-asthmatic population.

• Medications for asthma have been shown to be extremely safe. With the exception of very high doses of prednisolone for long periods of time, asthma medication of all types has not been associated with any increase in the rate of foetal malformation. Untreated asthma is more likely to cause a problem. In particular, attacks of asthma may reduce the amount of oxygen available to the foetus. Hence it is important to be meticulous with asthma control during pregnancy.

• If maintenance treatment with inhaled steroids was necessary before the pregnancy, it should be continued. The dose should be the minimum necessary to control symptoms and maintain normal or best lung function. Beclomethasone and budesonide have a long safety record in pregnancy. Currently, the approved product information for budesonide indicates it should not be giving during lactation.

• Likewise, although asthma medications do enter breast milk, the concentrations are usually so small that they do not have any adverse effect on the baby.

• If there is a strong genetic predisposition to atopic disease, then advice about primary prevention measures (encouragement of breast feeding, delayed introduction or avoidance of possible dietary triggers and control of the home environment to reduce allergen exposure) should be given. Cigarette smoking should be avoided.

• Peak flow monitoring and regular medical checks of the asthma during the pregnancy can provide reassurance to both the patient and the doctor delivering the baby.

Reprinted with permission from the National Asthma Campaign “Asthma Management Handbook 1998”.