Is it safe to use an albuterol (salbutamol) inhaler 3 to 4 times per week during pregnancy?

From the Guidelines

Using an albuterol inhaler 3-4 times per week during pregnancy is generally considered safe when needed to control asthma symptoms. Albuterol is the preferred short-acting inhaled beta 2-agonist because it has an excellent safety profile and the greatest amount of data related to safety during pregnancy of any currently available 1. According to the expert panel report 3 (EPR-3), maintaining asthma control during pregnancy is important for the health and well-being of both the mother and her baby, and it is safer for pregnant women to be treated with asthma medications than to have asthma symptoms and exacerbations 1.

Key points to consider:

• Albuterol is the preferred SABA due to the most data related to safety during human pregnancy being available for this medication 1
• Inhaled corticosteroids are the preferred long-term control medication, with budesonide being the preferred ICS because more data are available on using budesonide in pregnant women than are available on other ICSs 1
• Poorly controlled asthma poses greater dangers to both mother and baby than the medication itself, as it can lead to decreased oxygen supply to the fetus, preeclampsia, premature birth, and low birth weight
• The standard dosage is typically 1-2 puffs every 4-6 hours as needed for symptoms, but needing the rescue inhaler 3-4 times per week may indicate that asthma is not optimally controlled, and controller medications may need to be adjusted 1

It is essential to follow the healthcare provider's specific instructions regarding medication use during pregnancy and report any worsening symptoms promptly. Regular monitoring of asthma control and lung function during prenatal visits is also crucial to ensure the best possible outcomes for both mother and baby 1.

From the FDA Drug Label

Albuterol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. A reproduction study in CD-1 mice with albuterol ... showed cleft palate formation in 5 of 111 (4.5%) fetuses at 0.25 mg/kg and in 10 of 108 (9.3%) fetuses at 2.5 mg/kg. During worldwide marketing experience, various congenital anomalies, including cleft palate and limb defects, have been rarely reported in the offspring of patients being treated with albuterol.

The use of an albuterol inhaler 3 to 4 times per week during pregnancy is not explicitly addressed in the drug label. However, considering the potential risks, cautious use is advised. The label states that albuterol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Therefore, it is recommended to use albuterol inhaler with caution and under medical supervision, as the potential risks and benefits should be carefully weighed 2.

From the Research

Albuterol Inhaler Use During Pregnancy

• The provided studies do not directly address the safety of using an albuterol inhaler 3 to 4 times per week during pregnancy 3, 4, 5, 6, 7.
• However, the studies discuss the use of albuterol in combination with other medications for asthma management, which may be relevant for pregnant women with asthma.
• One study mentions the use of a combination of beclomethasone and albuterol in a single inhaler for mild asthma, but does not specifically address pregnancy 3.
• Another study discusses the use of budesonide/formoterol or budesonide/albuterol as anti-inflammatory reliever therapy for asthma, but also does not address pregnancy 4.
• There is no direct evidence in the provided studies to confirm the safety of using an albuterol inhaler 3 to 4 times per week during pregnancy.

Asthma Management and Albuterol Use

• The studies suggest that albuterol can be used as a reliever medication for asthma symptoms, and that it may be used in combination with other medications such as inhaled corticosteroids 5, 6, 7.
• One study found that inhaled salmeterol was more effective than albuterol in controlling asthma symptoms in patients with moderate to severe asthma 5.
• Another study found that inhaled corticosteroid use was associated with improved bronchodilator responsiveness to albuterol in some ethnic groups, but not others 6.
• The use of albuterol in combination with other medications, such as salmeterol/fluticasone propionate, has been shown to be effective in improving lung function and symptoms in patients with asthma 7.