From the Guidelines
Inhaled corticosteroids (ICS) are the recommended first-line controller therapy for pregnant women with asthma, with budesonide being the preferred option due to its extensive safety data during pregnancy. The goal of asthma management during pregnancy is to maintain optimal control to ensure adequate oxygen supply to the fetus, as uncontrolled asthma poses greater risks to both mother and baby than medication side effects 1. Low to medium doses of budesonide (200-400 mcg twice daily) are typically sufficient for most pregnant patients. For women who require additional control, a long-acting beta-agonist (LABA) such as formoterol or salmeterol can be added to the ICS in a combination inhaler 1.
Some key points to consider when managing asthma in pregnant women include:
- Short-acting beta-agonists (SABAs) like albuterol (salbutamol) are safe for rescue use as needed 1
- For severe asthma, higher doses of ICS or the addition of other controllers like leukotriene modifiers (montelukast) may be necessary, though with more limited pregnancy safety data
- Pregnant women should continue their pre-pregnancy asthma medications rather than stopping them, as the benefits of controlled asthma outweigh potential risks 1
- Regular monitoring every 4-6 weeks is recommended to adjust therapy as needed throughout pregnancy
It is essential to note that the treatment goal for the pregnant asthma patient is to provide optimal therapy to maintain control of asthma for maternal health and quality of life as well as for normal fetal maturation 1. Inadequate control of asthma is a greater risk to the fetus than asthma medications are. Proper control of asthma should enable a woman with asthma to maintain a normal pregnancy with little or no risk to her or her fetus.
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.
Recommended Inhaler Therapies for Pregnant Women with Asthma:
- Budesonide inhalation suspension may be considered for use in pregnant women with asthma, as studies have not shown an increased risk of abnormalities when administered during pregnancy 2.
- However, it is essential to closely monitor pregnant women with asthma and adjust medication as necessary to maintain optimal asthma control.
- Key Considerations:
- Disease-associated maternal and/or embryo/fetal risk
- Labor or delivery considerations
- Medication adjustment to maintain optimal asthma control
From the Research
Recommended Inhaler Therapies for Pregnant Women with Asthma
There are several inhaler therapies that can be used to manage asthma in pregnant women. The following are some of the recommended options:
- Albuterol via metered dose inhaler with spacer 3
- Budesonide/salmeterol in fixed-dose combination for the treatment of asthma 4
- Albuterol RespiClick dry-powder inhaler 5
- Albuterol via Turbuhaler 6
- Inhaled corticosteroid and long-acting β2-agonist combinations, such as fluticasone propionate/formoterol fumarate, fluticasone propionate/salmeterol xinafoate, budesonide/formoterol fumarate, and beclometasone dipropionate/formoterol fumarate 7
Safety Considerations
When using inhalers during pregnancy, it is essential to consider the safety of the medication and the device. The studies cited above suggest that the following inhalers are safe for use in pregnant women:
- Albuterol via metered dose inhaler with spacer 3
- Budesonide/salmeterol in fixed-dose combination 4
- Albuterol RespiClick dry-powder inhaler 5
- Albuterol via Turbuhaler 6
- Inhaled corticosteroid and long-acting β2-agonist combinations 7
Key Findings
The studies reviewed suggest that the following key findings are relevant to the use of inhalers in pregnant women with asthma:
- Albuterol via metered dose inhaler with spacer is effective in treating acute severe asthma 3
- Budesonide/salmeterol in fixed-dose combination is safe and effective for the treatment of asthma 4
- Albuterol RespiClick dry-powder inhaler is reliable, easy to use, and associated with a high level of patient satisfaction 5
- Albuterol via Turbuhaler is similar in efficacy and tolerability to albuterol via pressurized metered-dose inhaler 6
- Inhaled corticosteroid and long-acting β2-agonist combinations are effective in managing asthma and can be used in pregnant women 7