Review ArticleAsthma controller therapy during pregnancy
Section snippets
Material and methods
Published English-language studies of asthma controller medications in pregnant patients were identified through searches of MEDLINE (1966-February 2003), the Cochrane Controlled Trials Register and Database of Systematic Reviews (1988-February 2003), and EMBASE (1988-February 2003). An updated search of MEDLINE through June 2004 was also conducted. Classes of asthma controller medications (ie, inhaled corticosteroids [ICS], leukotriene modifiers, and long-acting β2-adrenergic agonists) and
Inhaled corticosteroids (ICS)
According to the NAEPP, ICS, because of their anti-inflammatory action, are the most effective class of asthma controller medications15, 18 and the preferred long-term controllers for persistent asthma of all severities in adults and children. Moreover, studies have shown that ICS significantly reduce the risk of an acute asthma exacerbation when used throughout pregnancy24 and significantly reduce the rate of asthma-related readmissions for pregnant women when used after discharge from the
Comment
Pregnancy category ratings for asthma controller medications are shown in Table VI. Medications rated Pregnancy Category B include nedocromil, cromolyn, and the leukotriene modifiers, montelukast and zafirlukast. Among ICS, only inhaled budesonide is rated Pregnancy Category B. Other ICS, along with theophylline, zileuton, and long-acting β2-adrenergic agonists, are rated Pregnancy Category C.
In a joint position statement published in May 2000, the ACOG and ACAAI recommended ICS as first-line
Conclusions
Uncontrolled asthma in pregnant women can result in perinatal complications and exacerbations, which can be life-threatening for the mother and fetus. Because these risks are greater than those of adverse effects because of controller medication use, women with asthma should receive controller therapy during pregnancy. Although recommendations from the ACOG and ACAAI can serve as a basis for prescribing asthma medications safely during pregnancy, new safety and efficacy data must be considered
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Longitudinal Changes in Upper and Lower Airway Function in Pregnancy
2023, Immunology and Allergy Clinics of North AmericaCitation Excerpt :Treatment is similar to the nonpregnant population—avoiding triggers and using nasal corticosteroids and antihistamines.10 Considered first-line therapy, intranasal corticosteroids have a safety profile comparable to inhaled corticosteroids.11,12 A 2016 systematic review found no high-quality studies available on rhinitis treatment during pregnancy, therefore providing expert panel recommendations such as the use of nasal corticosteroids for chronic rhinosinusitis maintenance therapy.13
Management of Mastocytosis in Pregnancy: A Review
2017, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Cromolyn, a mast cell stabilizer, is a frequently used medication in mastocytosis for the reduction of gastrointestinal symptoms, such as abdominal pain and diarrhea, pruritus, and flushing.1-3,33 It has been designated a pregnancy category B medication and has not demonstrated any increased risk of major congenital malformation.29 Leukotriene receptor antagonists, such as montelukast, are used in mastocytosis for flushing, musculoskeletal pain, and bronchoconstriction.11
Asthma in pregnancy and its pharmacologic treatment
2010, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :We found that more than 14% of women in our study reported physician-diagnosed asthma. Although this is higher than previously reported,2,15,16 it may not be inconsistent with other observations. It is known that the prevalence of asthma increased through the 1990's,3,17,18 and because our data are derived from 1998-2006, the increasing prevalence may account in part for our higher rates.
Asthma during pregnancy
2009, Revue Francaise d'AllergologieInhaled corticosteroids during pregnancy: A review of methodologic issues
2008, Respiratory MedicineCitation Excerpt :In their publications, some authors acknowledged the difficulties associated with the lack of power and provided the reader with useful information about power calculations.10,16,18,19 Further, some recent review articles on the safety of asthma medications during pregnancy35,39–43 also acknowledged the power limitations of several studies.35,39,42,43 However, it is important to recognize that small sample sizes in studies could be due to the difficulty recruiting pregnant women with asthma and that the lack of adjustment could be due to the complexity in obtaining suitable information about potential confounding variables.35
Supported by AstraZeneca LP, Wilmington, Delaware. Research funding was also received from Genentech, GlaxoSmithKline, Novartis, and Sepracor (J.C.G.).