Asthma is an inflammatory lung disease that is
characterized by narrowing of the airways leading to reversible obstruction of
airflow and bronchospasm. Asthma may not necessarily aggravate during
pregnancy. It is possible that some women may experience an improvement in the
symptoms while others may experience no change in symptoms.
While it is possible that certain factors like
estrogen or progesterone mediated bronchodilation or descent of fetus may
improve the symptoms of asthma during pregnancy, the symptoms are likely to
worsen in situations of increased stress, gastro esophageal reflux and
increased occurrence of bacterial respiratory tract infection. It has been
observed that asthma symptoms usually increase during the sixth month of
gestation, however, the exacerbations tend to decrease during the final month
Studies indicate an increase in the number of
hospitalization rates in pregnant women with asthma making it all the more
crucial to control asthma with proper medication during pregnancy. Pregnant
women with severe asthma are more likely to experience the worsening of the
symptoms and have high chances of complications as compared to women with mild
asthma. The chances of exaggeration of asthma leading to hospitalization also
depend upon the severity of diseases before pregnancy. Studies have proved a
significant relationship between an increase in asthma severity and decreased
fetal growth. A pregnant woman with asthma is more likely to experience
adverse complications like -
• Preterm delivery,
• Infant being small for gestational age,
• Congenital malfunctions,
• Placenta previa
• and Cesarean delivery.
with asthma may also suffer from hypertensive disorders, antepartum and
postpartum hemorrhage, membrane related disorders, gestational diabetes and
preterm delivery. Thus emphasis needs to be placed on controlling the asthma in
In order to control the symptoms it is necessary
to identify the factors that aggravate the disease. Patients with asthma
should try to reduce their exposure to animal dander, dust, mites and other
environmental triggers. Gastro esophageal disease is also known to
exacerbate asthma. Patients with this disease should avoid food and drink
within 3 hours of bedtime and are advised to take smaller meals.
Asthma can be treated
with two categories of medication: Controller medications that prevent asthma
and Rescue medications that prevent the symptoms of asthma. Controller
medication includes Inhaled Corticosteroids (ICSs) which control the
inflammation of airways and are preferred controller therapy for pregnant
women. Corticosteroids like Budesonide are preferred during pregnancy because
of their proven efficacy and safety.
For patients whose asthma symptoms cannot be
controlled by ICSs alone, Long Acting Beta Agonists (LABAs) are preferred as
add on therapy.
Though they have certain side effects associated with them they are safer for
pregnant women as compared to other add on therapies like Theophylline,
Cromolyn or Leukotriene Modifiers.
On the other hand Rescue medications include short acting beta agonists (SABA) such as albuterol that are comparatively safer as no significant
relationship is found between SABAs use and congenital malformations, preterm
delivery rate or infant growth restriction.
Careful monitoring of the asthma helps control
the symptoms and is recommended for all pregnant patients with asthma. Fetal
evaluation helps predict the progression of the fetal growth and thus is
extremely important. Asthma exacerbation often results in uterine
contractions but rarely leads to emergency cesarean delivery. Once asthma
symptoms are controlled, the contractions subside.
medications should be continued during labor and delivery. The use of
theophylline, antihistamines, ICSs, beta agonists and cromolyn are safe for
women who are breastfeeding as only a small amount of asthma medications enter
It is crucial for pregnant women to recognize the
factors that aggravate the asthma symptoms and identify the proper medication
to control asthma for the health of the fetus.