Can a 31-week pregnant woman with asthma take steroids (corticosteroids) for an exacerbation while on aspirin (acetylsalicylic acid)?

Steroids for Asthma Exacerbation in a 31-Week Pregnant Woman on Aspirin

Systemic corticosteroids should be administered to treat asthma exacerbation in a 31-week pregnant woman on aspirin, as the benefits of treating asthma during pregnancy outweigh the risks of untreated asthma to both mother and fetus. 1

Recommended Treatment Approach

First-Line Therapy

• Oral corticosteroids: Prednisone 40-60 mg daily for 5-10 days 1
  • No need to taper for courses less than 1 week
  • Alternative options: Methylprednisolone 60-80 mg/day or prednisolone 60 mg/day for 3-10 days 2
  • Continue until peak expiratory flow reaches 70% of predicted or personal best

Concurrent Medications

• Short-acting bronchodilators: Albuterol is the preferred agent during pregnancy 1
• For severe exacerbations: Consider adding ipratropium bromide 2
• Maintain aspirin therapy: While corticosteroids and aspirin together may increase risk of gastrointestinal side effects, this is a short-term treatment and the benefits outweigh the risks 3

Safety Considerations

Maternal and Fetal Risks

• Uncontrolled asthma poses greater risks to mother and fetus than medication side effects, including:
  • Increased perinatal mortality
  • Preeclampsia
  • Preterm birth
  • Low birth weight 1

Medication Interactions

• Aspirin + corticosteroids: May increase risk of gastrointestinal side effects 3
  • For short courses of steroids, this risk is generally acceptable
  • No need to discontinue aspirin during steroid treatment

Common Pitfalls to Avoid

1. Undertreating asthma due to pregnancy concerns - this is more dangerous than medication side effects 1
2. Unnecessary tapering of short-course systemic corticosteroids 1
3. Delaying treatment - prompt administration of corticosteroids is essential 4
4. Withholding steroids - pregnant women are often undertreated in emergency settings (50.8% of pregnant women vs 72.4% of non-pregnant women receive appropriate systemic corticosteroids) 4

Follow-Up Recommendations

• Monthly evaluations of asthma during pregnancy 2
• Consider initiating or continuing inhaled corticosteroids after the acute exacerbation resolves 1
• Budesonide is the preferred inhaled corticosteroid during pregnancy (Category B) 5

Evidence Quality

The recommendations are based on established guidelines from the American College of Allergy, Asthma, and Immunology and the National Asthma Education and Prevention Program. Studies consistently show that the risks of uncontrolled asthma during pregnancy exceed the risks of medication use 1, 5. Research demonstrates that pregnant women are often undertreated for asthma exacerbations 4, highlighting the importance of appropriate corticosteroid therapy.