From the Guidelines
Asthma treatment during pregnancy should prioritize the use of inhaled corticosteroids (ICS) such as budesonide, with the addition of long-acting beta-agonists (LABAs) like salmeterol or formoterol for moderate to severe cases, as recommended by the most recent guidelines 1.
Key Considerations
- Inhaled corticosteroids are the preferred controller medications due to their strong effectiveness and safety data in pregnant women 1.
- Budesonide is the preferred ICS because it has the most safety data available, but other ICS like fluticasone and beclomethasone are also considered safe 1.
- Short-acting beta-agonists (SABAs) such as albuterol are recommended as rescue medications 1.
- Leukotriene modifiers like montelukast may be continued if they were effective before pregnancy, but their safety data during pregnancy is limited 1.
- Oral corticosteroids can be used for severe exacerbations, but their use should be carefully considered due to potential risks to the fetus 1.
Medication Safety During Pregnancy
- The safety of asthma medications during pregnancy is a crucial consideration, with ICS and SABAs having the most reassuring data 1.
- The use of LABAs in combination with ICS is supported by evidence showing improved asthma control with a similar safety profile to short-acting beta-agonists 1.
- Regular monitoring of asthma symptoms and adjustments to medication as needed are essential to maintain good control and minimize risks to the fetus 1.
Recommendations
- Pregnant women with asthma should work closely with their healthcare provider to develop a personalized treatment plan that prioritizes their health and the health of their fetus 1.
- The treatment plan should include education on recognizing and managing asthma symptoms, avoiding triggers, and using medications as prescribed 1.
- By prioritizing good asthma control and carefully selecting medications, pregnant women with asthma can reduce their risk of complications and ensure the best possible outcomes for themselves and their babies 1.
From the FDA Drug Label
- 1 Pregnancy Risk Summary There are no adequate well-controlled studies of budesonide inhalation suspension in pregnant women. However, there are published studies on the use of budesonide, the active ingredient in budesonide inhalation suspension, in pregnant women Studies of pregnant women have not shown that inhaled budesonide increases the risk of abnormalities when administered during pregnancy.
Budesonide inhalation suspension is allowed for pregnant patients with asthma, as studies have not shown an increased risk of abnormalities when administered during pregnancy 2.
- Key points:
- No adequate well-controlled studies in pregnant women
- Published studies on budesonide use in pregnant women show no increased risk of abnormalities
- Pregnant women with asthma should be closely monitored and medication adjusted as necessary to maintain optimal asthma control.
From the Research
Asthma Treatment for Pregnant Patients
- Most medications used to control asthma in the general population can be safely used in pregnant women 3
- Inhaled beta-adrenoceptor agonists (beta-agonists), cromolyn sodium (sodium cromoglycate), and inhaled and systemic corticosteroids are well tolerated by the fetus 3
- Budesonide and beclomethasone are preferred inhaled corticosteroids for the treatment of asthma in pregnancy 3
- Leukotriene receptor antagonists zafirlukast and montelukast can be used in pregnancy, but only in special circumstances 3
- Zileuton should not be used in pregnancy 3
Medication Options
- Inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) can be used in combination for the treatment of persistent asthma 4, 5, 6, 7
- Salmeterol/fluticasone propionate (SFC) and formoterol/budesonide (FBC) are two combination products available for the treatment of persistent asthma 6
- Budesonide/formoterol inhalation aerosol (Symbicort) is an ICS and LABA combination approved for the long-term maintenance treatment of persistent asthma 7
Treatment Considerations
- Acute asthma exacerbations in pregnant women should be treated similarly to those in non-pregnant patients 3
- Maternal blood glucose levels should be monitored periodically in pregnant women receiving systemic corticosteroids 3
- Maternal arterial oxygen saturations should be kept above 95% if possible for fetal well-being 3