Managing Asthma with Short-Acting Beta-Agonists Could Impact Fertility

Luke E. Grzeskowiak, PhD

A new study suggests that use of short-acting beta-agonists (SABA), a common medication used for asthma control, may reduce fertility in women.

Luke E. Grzeskowiak, PhD, National Health and Medical Research Career Fellow at Adelaide Medical School, University of Adelaide, Australia, told MD Magazine that many women express concerns about the use of asthma medications during pregnancy because studies have shown maternal asthma to be associated with serious pregnancy complications and infant morbidity.

“We wanted to explore that relationship further and see what roles medications played, if any, on fertility,” Grzeskowiak said.

Study subjects, healthy women who had never given birth, were recruited to the Screening for Pregnancy Endpoints (SCOPE) study, a multicenter prospective cohort study whose aim is to develop screening tests for prediction of pre-eclampsia, spontaneous preterm birth and small-for-gestational-age infants.

Out of the 5617 subjects, 1106 self-reported doctor-diagnosed asthma. Among those, 450 were classified as former asthmatics (no symptoms for the past 12 months and no use of asthma medications) and 656 as current asthmatics (symptoms within the past 12 months and use of asthma reliever or preventer medications). Compared to non-asthmatics, women that were either current or former asthmatics were younger, had higher BMIs, were more likely to smoke, be of Caucasian ethnicity, and have lower social-economic status.

Those with current asthma were then divided into those that use intermittent reliever medications only (SABA) or additional use of reliever medications, as defined as inhaled corticosterioids (ICS) with or without long-acting beta-agonists (LABA). The resulting subgroups were former asthmatics, those that use SABA, and those that use ICS plus LABA.

Time to pregnancy (TTP) was defined as the duration of sex without contraception before getting pregnant and was self-reported. Subfertility was defined as TTP greater than 12 months.

Results showed that the chances of getting pregnant for current asthmatics who managed their symptoms with SABAs was 15% lower (0.85; 95% CI; 0.75 to 0.96) when compared to non-asthmatics. No difference was observed for former asthmatics (1.00; 95% CI; 0.89 to 1.13) or current asthmatics using ICS plus LABAs (0.98; 95% CI; 0.84 to 1.15). Point estimates for subfertility increased among women using SABAs (OR 1.30; 95% CI; 0.93 to 1.81), but not for former asthmatics (0.89; 95% CI; 0.62 to 1.28) or current asthmatics using ICS plus LABAs (1.08; 95% CI; 0.69 to 1.71), compared to non-asthmatics.

“While we found that asthma was linked to reduced fertility, we saw that this relationship was only observed among the group of women relying on short-acting asthma relievers alone to manage their symptoms,” Grzeskowiak said. “No relationship between the use of long-acting preventer asthma medications and fertility was seen, which provides reassuring evidence that women requiring these medications to maintain good asthma control can continue to take these when trying to conceive.”

Grzeskowiak said the main limitations of this study is that they did not follow subjects from the point that they began trying to conceive and researchers were reliant on subject’s recall of how long it took to get pregnant.

“Additional studies are needed to see whether improving asthma control can improve fertility,” Grzeskowiak said. “What we do know, is that improving asthma control prior to pregnancy sets women up for the best possible pregnancy outcomes.”

The study, "Asthma treatment impacts time to pregnancy: evidence from the international SCOPE study," was published online in the European Respiratory Journal.

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