Are there situations where a pregnant patient should avoid using her albuterol (salbutamol) inhaler?

When to Avoid Albuterol in Pregnancy

No, there is essentially no situation where a pregnant patient with asthma should avoid using her albuterol inhaler—the risks of uncontrolled asthma far exceed any theoretical medication risks, and albuterol is the preferred short-acting bronchodilator during pregnancy. 1, 2

Core Principle: Uncontrolled Asthma is More Dangerous Than Medication

• Inadequate asthma control poses greater risk to the fetus than albuterol itself, as uncontrolled asthma decreases oxygen supply to the fetus and can cause serious complications including perinatal mortality, preeclampsia, and low birth weight. 1, 2
• Albuterol has the most extensive safety data of any short-acting beta-agonist in pregnancy, with reassuring evidence from 6,667 pregnant women including 1,929 with asthma. 1
• The Australian Therapeutic Goods Administration classifies salbutamol (albuterol) as Category A, indicating compatibility during pregnancy, while the FDA lists it as Category C—but clinical guidelines explicitly support it as first-choice therapy despite the FDA classification. 1, 2

Appropriate Use During Pregnancy

For symptom relief:

• Use 2-4 puffs via metered-dose inhaler as needed for acute symptoms. 3, 2
• Up to 3 treatments at 20-minute intervals or single nebulizer treatment (2.5 mg) for acute exacerbations. 3, 1

Red flags requiring controller therapy escalation:

• If albuterol is needed more than twice weekly in intermittent asthma, or if use is increasing in persistent asthma, this signals inadequate control requiring initiation or intensification of inhaled corticosteroids (preferably budesonide). 3, 2
• Using approximately one canister per month indicates poor asthma control even if not using it daily. 3

Important Caveats About Route of Administration

While inhaled albuterol is safe and preferred, systemic administration (oral or intravenous) can cause problematic effects:

• Maternal and fetal tachycardia 1
• Maternal hyperglycemia leading to neonatal hypoglycemia 1
• Potential arrhythmias, tremor, and hypokalemia with excessive dosing 4

However, these concerns apply to systemic routes or excessive dosing—not to appropriate inhaled use for asthma. 1, 4

The Only True Contraindication

The single scenario where albuterol should not be used is in a non-asthmatic pregnant woman without bronchospasm, as there would be no medical justification and only potential for adverse cardiovascular and metabolic effects without benefit. 4

Special Considerations

• During labor: Acute asthma exacerbations during labor are rare, and albuterol remains safe. However, avoid ergot derivatives (ergometrine) which can cause severe bronchospasm in asthmatic patients. 5
• Monitoring: Monthly evaluation of asthma control and pulmonary function is recommended throughout pregnancy, as asthma course changes in approximately two-thirds of pregnant women (improves in one-third, worsens in one-third). 1, 2
• Drug interactions: Albuterol should be used with extreme caution in patients on MAO inhibitors or tricyclic antidepressants, and beta-blockers will inhibit albuterol's effect. 6

Bottom Line for Clinical Practice

Never discontinue or discourage albuterol use in pregnant asthmatic patients. 7 The most common cause of worsening asthma in pregnancy is medication non-compliance, often from unfounded fears about medication safety. 5 Emphasize to patients that fetal well-being depends on maternal well-being and adequate oxygenation, which requires effective asthma control. 5, 7