Asthma in Pregnancy (cont.)
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Most people with asthma take at least two medications: one for long-term prevention and control of asthma symptoms and one for quick "rescue" in case of an attack. The long-term medications are taken daily, even if there are no symptoms.
During pregnancy, inhaled corticosteroids are the mainstay for long-term control. Long-term medications are sometimes combined into single preparations, such as an inhaled steroid and a long-acting beta-agonist.
Rescue medications are taken only when symptoms appear. Inhaled short-acting beta-agonists are usually the first choice for fast relief of symptoms.
Control and Preventive Medications
Inhaled corticosteroids: Corticosteroids prevent symptoms by preventing the swelling and mucus secretion that go along with inflammation. They help prevent severe asthma attacks. They are the most popular long-acting asthma drugs for pregnant women because they work well and are considered to be safe in pregnancy. They cause few side effects. Examples include budesonide (Pulmicort) and beclomethasone (Vanceril, Beclovent, Qvar).
Leukotriene inhibitors: These drugs work by blocking a substance that is produced by cells in your body (leukotrienes) that causes swelling and spasm of airways. These drugs are considered safe during pregnancy, but in general they do not work for as many people as inhaled steroids. Examples are montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo).
Long-acting beta-agonist inhalers: These medications often are used in combination with inhaled steroids for severe or nighttime symptoms. They also are used to prevent exercise-induced asthma. Since their action is delayed, they are not used for rescue treatment (see short-acting beta-agonists below). Examples of long-acting beta-agonists include salmeterol (Serevent) and formoterol (Foradil).
Methylxanthines: These medications relax the airway walls. They have been linked to preterm labor, but in general they are thought to be safe in pregnancy. They are not used as much as the other long-term medications because they don't work for as many people. The most widely used example is theophylline (Slo-bid, Uniphyl). Because pregnancy can change the concentration of this medication in the bloodstream, checking levels of theophylline may be required, even if you were taking it before.
Others: These medicines prevent swelling in the airway. They are used mostly to prevent attacks triggered by exercise, cold air, or allergies. They are considered safe in pregnancy, but they do not work in as many people as other long-term control medications. Examples include cromolyn (Intal) and nedocromil (Tilade).
Short-acting beta-agonist inhalers: These inhaled medications quickly dilate the airways, relieving tightness, wheezing, and shortness of breath. They are relatively safe in pregnancy because only small quantities are absorbed into the bloodstream. These drugs generally have little negative effect on the fetus. An example is albuterol (Proventil, Ventolin).
Oral corticosteroids (taken as a pill): These medications are taken only for a short time until other medications begin to work and asthma is controlled. Their use during pregnancy is controversial, but most evidence points to their being safe. Although there may be a very small risk of cleft lip or palate when used during the first trimester, a severe asthma attack in the mother can put the life of the fetus at risk. Examples include prednisone (Deltasone) and methylprednisolone (Medrol).
Anticholinergic agents: In inhaled form, these drugs are used in addition to a beta-agonist (or instead of a beta-agonist in people who cannot take beta-agonists) to relieve severe symptoms. An example is ipratropium bromide (Atrovent, Combivent).
Medications to Avoid
Antihistamines and decongestants: These medications are used to relieve stuffy, runny, or itchy nose, itchy or watery eyes, and other minor allergy symptoms. Although some decongestants might carry a small risk of birth defects when used early in pregnancy, their safety in pregnancy has not been fully studied.
If possible, avoid regular use of epinephrine and other related medication (alpha-adrenergics) as they may pose a higher risk to the fetus. Epinephrine may be given as an injection to treat a severe asthma attack or a life-threatening allergic response. If this situation occurs, treating your reaction effectively and quickly is important to decrease the risk of oxygen deprivation to the fetus.
Aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs): These medications are used to relieve headaches, muscle pain, inflammation, and fever. They are not recommended during late-term pregnancy.
Heartburn and gastroesophageal reflux disease (GERD) are common in pregnancy. They can often be treated without medications by elevating the head of the bed, avoiding overeating, avoiding food triggers, and not eating within two to three hours before bedtime. If medications are needed to control heartburn and GERD, avoid regular use of antacids that contain bicarbonate and magnesium.
Irina Petrache, MD
Catherine Sears, MD
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