Managing Asthma During Pregnancy: Challenges and Recommendations

Jenny Huang, MD

Credit: San Diego Allergy Society

Asthma affects a significant number of pregnant individuals and according to an article published in JAMA, diagnosis, evaluation, and treatment recommendations for those who are pregnant follow similar principles as for nonpregnant patients.¹

The unique challenges, such as treatment barriers and the need for fetal safety considerations, were addressed by a couple of investigators including Jenny Huang, MD, Department of Allergy, Asthma, and Immunology, Scripps Clinic.

The impact of uncontrolled asthma during pregnancy can lead to adverse outcomes for both the mother and the baby, including preterm birth, low birth weight, and preeclampsia. Timely diagnosis, evaluation, and appropriate management of asthma are crucial to minimize potential risks.

The article stated asthma is estimated to affect 8.4% to 8.8% of pregnant individuals, making it one of the most common medical conditions during pregnancy. While 60% of pregnant individuals with known asthma experience no change in their symptoms, 40% experience a worsening of their asthma according to recent data.

Investigators noted these findings contradict previous observations suggesting that one-third of patients experience improvement, one-third have no change, and one-third have worsening symptoms which can lead to emergency department (ED) visits, hospitalization, and could possibly be fatal.

Diagnosing Asthma in Pregnant Individuals

Differential diagnoses include dyspnea of pregnancy, inducible laryngeal obstruction, anxiety with panic attacks, postnasal drip, and reflux. Measuring lung function with spirometry can be used during pregnancy to confirm the diagnosis.

Additional diagnostic tools, such as FeNO (fraction of exhaled nitric oxide) measurements, can be used with pregnant patients to monitor eosinophilic airway inflammation. However, investigators reported certain diagnostic tests, like methacholine challenges and chest radiographs, are contraindicated.

Treatment barriers for asthma during pregnancy can stem from provider and patient concerns about potential harm to the unborn child and inadequate communication between clinicians and patients. It's possible for pregnant individuals to hesitate the initiation or continuation of medications due to worries about fetal safety.

Studies have shown patients often decrease or stop using asthma medications during pregnancy, despite an increase in their symptoms. Therefore, the article emphasized that education about the importance of asthma control and adherence to medications is crucial in addressing these barriers.

Treatment Practices and Barriers

Nonpharmacologic management of asthma during pregnancy focuses on allergen avoidance, stress management, breathing exercises, and maintaining a healthy lifestyle. Avoiding exposure to triggers such as pets, pests, and airborne allergens is important.

Stress management techniques, including meditation and exercise, can help alleviate symptoms. Pharmacologic management involves a stepwise approach, similar to nonpregnant patients, utilizing medications such as inhaled corticosteroids (ICS) and short-acting bronchodilators.

Approximately 5.8% of pregnant individuals experience asthma exacerbations requiring hospitalization. Risk factors for exacerbations include severe or difficult-to-control asthma, medication nonadherence, obesity, viral infections, and reflux.

Prompt treatment of exacerbations was stated as hospitalization for severe cases, oxygen supplementation, bronchodilators, and corticosteroids. Additional interventions such as intravenous or inhaled magnesium may be necessary in severe cases.

"There may be several barriers to asthma control and treatment in pregnancy, but control of asthma is imperative because poor control may result in several adverse outcomes for both mother and child," investigators wrote. "Clinicians and patients should work together to achieve optimal control of asthma during pregnancy."

References:

1. Huang J, Namazy J. Asthma in Pregnancy. JAMA. 2023;329(22):1981–1982. doi:10.1001/jama.2023.5588