One in 10 pregnant women worldwide has asthma. Asthma symptoms worsen in one-third of women, improve in one-third, and remain similar in another third; however, these changes are variable from woman to woman, and pregnancy to pregnancy.
At least 20 to 45% of women have been reported to have an exacerbation of asthma requiring medical intervention during pregnancy, including unscheduled doctor visits, emergency department (ED) presentations, hospitalization, or requirement for oral corticosteroids. Severe exacerbations requiring oral corticosteroids use have been reported in 5 to 11% of women.
A 2011 systematic review and meta-analysis described the increased risks of poor perinatal outcomes associated with maternal asthma, including preterm birth, low birth weight, and preeclampsia.
Asthma in pregnancy guidelines recommend that asthma exacerbations be treated in the same way as nonpregnant women, and emphasize that exposure to asthma medications to appropriately treat exacerbations poses less risk than exposure to exacerbations themselves.
There is ample reassuring data to support the safety for budesonide (ICS) and Albuterol (SABA), and the recommendation that asthma medications be used in pregnancy, as for nonpregnant women. Guidelines also recommend the continued use of ICS medication that has been effective in controlling asthma before pregnancy.
Review of asthma symptoms every 4 weeks is recommended. Guidelines recommend a stepwise approach to treatment adjustment for asthma, and these clinical decisions are made primarily upon symptoms and lung function. However, a novel approach has been suggested, whereby asthma treatment decisions are made according to the level of eosinophilic lung inflammation, which is responsive to ICS treatment. The level of eosinophilic inflammation may be ascertained using FENO (exhaled nitric oxide).
Pregnant women with asthma are at risk of numerous comorbidities, which may impact their asthma, including rhinitis, GERD, cigarette smoking, obesity, and anxiety and depression. These issues need to be addressed.