Q: What constitutes the optimal management of asthma in a pregnant patient?
A: Asthma management in a pregnant patient is, in principle, the same as in any other patient—with a few exceptions.
For optimal health of both mother and fetus, keep the asthma completely under control, using any of the approved medications—including corticosteroids. Medications may be tapered or discontinued if the asthma improves during the pregnancy.
Concern formerly existed about the development of cleft lip and palate when systemic corticosteroids were used during the first trimester of pregnancy. No confirmation of this alleged association has been established. A recent study suggests some minimal risk of cleft palate, but not a strong association.1
Theophylline may cause heartburn because it increases gastric secretions and relaxes the gastroesophageal sphincter; however, this agent is rarely used in the maintenance management of asthma. All other asthma drugs—including β-agonists and inhaled corticosteroids, the mainstays of asthma control— may be used during pregnancy. Little is known, however, about the effects of leukotriene inhibitors on pregnant women.
Advise your pregnant patients to avoid known asthma triggers, such as irritants and allergens, whenever possible.
Spirometry, a reliable tool for periodic clinical evaluation, is advisable in patients with moderate or severe asthma.