Overview Of Treatment Of Asthma In Pregnancy

Treating Asthma in pregnancy may require use of different medicines. Given the complexities of the combination of asthma with pregnancy, some awareness about how effects of medicines in Asthma can be different, is required. An early reporting of an adverse effect can be a difference between smooth management and exacerbation of either asthma or pregnancy complications.
Overview of Treatment of Asthma in Pregnancy
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Asthma in Pregnancy: An Overview

Asthma can get exacerbated in pregnancy, and when it does, it poses significant dangers to the health of fetus as well as the mother. The basic principle underlying the treatment of asthma during pregnancy is the fact that the adverse effects of medicines used in treating asthma are safer compared to the complications arising from poorly controlled asthma in pregnancy. Thus, every endeavor should be targeted to achieve the goal of keeping asthma under control during a pregnant state.

A lot of research has already been attempted to identify safe treatment of asthma in pregnancy, and there

is overwhelming evidence that most medicines used in normal treatment of asthma do not lead to serious side effects when used in pregnancy, unless there is an overdose of medication. Thus, the accepted strategy is to continue treatment keeping the dose to the minimum effective and avoid all triggers of asthma.

Medication for Asthma in Pregnancy

The treatment of asthma in pregnancy is centered around following medicines:
1. INHALED CORTICO-STEROIDS – Inhaled steroids are considered very safe in pregnancy and are usually the choice for long term treatment. The preferred steroid is Budenoside (Pulmicort) which has been extensively evaluated in studies and found safe. The dose of steroids should be kept at usual dose, or as prescribed by the physician. Importantly, one should be regular and not miss the doses.

2. LONG ACTING BETA 2 AGONISTS – Two medicines in this group, Salmeterol and Formeterol are available, and considered reasonably safe, but are used only when control of asthma is not achieved with inhaled steroids alone. Usually they are added to the steroid inhalation.

3. SHORT ACTING BETA 2 AGONISTS – This group is represented by Albuterol (Salbutamol) which is used either in case of those who do not require regular treatment but develop sudden attack, or in case of occasional exacerbation of asthma. It is considered safe when used for short periods and is used only to control the exacerbations.

4. CROMOLYN – It is considered very safe in pregnancy, but is less effective than long acting steroid inhalation, hence used only as the second alternative when control with steroids alone is unsatisfactory.

5. LEUKOTRIENE INHIBITOR - Zafirlukast (Accolate), Montelukast (Singulair) and Zileuton (Ziflo) act by preventing Leukotrienes, which exacerbate asthmatic inflammation. Limited data on their safety profile is available, though many practitioners are confident about its use.

6. SYSTEMIC STEROIDS – These are sometimes required in cases of acute attack.


If used for longer durations, they do impose a risk of genetic deformities in the child, but they are life saving medicines and are often used to treat severe asthma attacks in pregnancy.

7. THEOPHYLLINE – It is another alternative medicine, which can also be combined with other medicines to control asthma. In normal doses, it is safe, but over dosage can cause problems and side effects. Hence its dose needs to be carefully calculated and adhered to.

Choice & Principles of Treatment

One must remember that modifying the prescribed treatment on your own can be more dangerous in pregnancy. So, one must adhere strictly to the prescription. During pregnancy, it is preferable that any other medicine may also be taken only with the advice of the same physician who is treating for asthma, thus it is preferable that medicines for asthma prescribed by a different physician be brought to the notice of the treating obstetrician at the earliest.

Since asthma per se is far more dangerous than the side effects of the treatment, one should immediately bring any signs of exacerbation to the notice of the physician, and the necessary treatment for an acute attack must begin as early as possible.

Those who have a history of asthma but are not on regular treatment, should keep short acting beta 2 agonist, like Albuterol inhalations, available with them, and with consultation of physician, can start it immediately, if there are any signs of asthma. For those requiring regular treatment, steroid inhalations are usually the choice, but as per the need they can be supplemented by other medicines like long acting beta 2 agonists, Cromolyn or Theophylline. For severe attacks, short acting beta 2 agonists are often combined with steroids. In severe cases, systemic treatment may be required, and can often be life saving.

Finally, one must not forget that prevention is better than cure and avoiding exposure to known or potential allergens and preventing infections by healthy life sftyle go a long way in helping control of asthma during pregnancy.
 



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