Asthma in pregnancy

Asthma continues to impose a significant clinical and economic burden on patients and society. Asthma is a comorbid condition in approximately 4% of all pregnancies; the incidences of asthma itself and asthma in pregnancy seem to be rising. In pregnancy, approximately one third of women who have asthma experience worsening of their condition, one third remains the same, and one third improves [38]. Objective testing is key for the evaluation of asthma because patients and physicians tend to underestimate the severity of the disease. Testing may include office spirometry which measures FEV₁ or peak flow meter which correlates with FEV₁ measures. Patients should have optimal measurement of FEV₁ or peak flow meter in a symptom-free period. This optimal value should be used to guide therapy treatment throughout the pregnancy. For patients who have mild disease, daily long-acting β-agonists are the first-line therapy. For patients who have moderate persistent asthma, the preferred treatment includes the daily use of a combination of low-dose inhaled corticosteroids and long-acting β-agonists. For patients who have severe persistent asthma, the currently recommended treatment is combination therapy with high-dosage ICSs and long-acting β-agonists. If needed, corticosteroid tablets or syrup (2 mg/kg/d, not to exceed 60 mg/d) can be added to maintain control; however, all attempts should be made to reduce the use of systemic corticosteroids and to maintain control with high dosages of ICSs. The most important aspect may be prevention. Avoidance of triggers, such as cigarette smoke, pets, dust, and stress, is vital. Another key point is that women should take medications daily, on a regular schedule, not just when symptoms arise. Peak flow should be done daily at home and recorded by the patient. These values should be brought to the regular appointments and reviewed with the patient. Medications should be adjusted based on the objective lung tests of peak flow and spirometry. It should be emphasized to the patient that her asthma medications pose less risk to the infant than a serious asthma attack. Furthermore, daily medications are more effective than medications that are begun after an attack has started.