Asthma in pregnant woman and its management : a review

  • Farni Yuliana Pratiwi Magister of Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta
  • Hadiatussalamah Magister of Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta
  • Intan Adevia Rosnarita Magister of Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta
  • Yuda Anzas Mara Magister of Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta
  • Novia Ariani Dewi Master of Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta
Keywords: asthma, pregnancy, treatment, prenatal, congenital malformations

Abstract

Asthma is the most common comorbidity in pregnant women and gives 30% of exacerbation experience. The other 30% will see improvement of their symptoms, and the rest will not see the changes. Exacerbations have become a major clinical concern in pregnant women. Medical concerns for the mother and the childbirth included low birth weight, preeclampsia, and preterm delivery. The major goal is to keep asthma under control to ensure mother's health and well-being, as well as fetal growth. Controlling asthma and preventing exacerbations are the main goals of asthma treatment during pregnancy. Treatment for asthma should ideally begin before conception. This is to avoid day-time and night-time symptoms, as well as to keep lung function. Furthermore, fetal oxygenation is a crucial factor during the pregnancy. With a few exceptions, asthma drugs are basically the same in pregnancy as they are in non-pregnant people. Inhaled corticosteroids (ICS) are often used as a controlling treatment. Budesonide is the recommended ICS. Short-acting β-agonist (SABA) preferable as reliever in acute asthma and to relieve exacerbation. As an add-on therapy for medium to high dose ICS, long-acting β-gonists (LABA) is often used. Virus infections and ICS nonadherence are the two most common causes of asthma exacerbations during pregnancy.

References

Aly, Hany., et al. Maternal asthma, race and low birth weight deliveries. J Early Human Development 87 (2011) 457–460.
Barman, RC., et al. Treating Asthma in Pregnancy - An Update. Faridpur Med. Coll. J. 2013;8(2):85-91.
Blais L, Forget A. 2008. Asthma exacerbations during the first trimester of pregnancy and the risk of congenital malformations among asthmatic women. J Allergy Clin Immunol 121(6):1379–1384, 84 e1.
Bobrowski RA. Pulmonary physiology in pregnancy. Clin Obstet Gynecol 2010;2:285-300.
Demissie., et al. Maternal Asthma and Transient Tachypnea of the Newborn. J Pediatrics Vol. 102 No. 1 July 1998.
Gaiser R. Physiologic changes of pregnancy. In: Chestnut D, Wong C and Tsen L (eds) Chestnut’s obstetric anesthesia: principles and practice. Philadelphia: Elsevier 2009: 1382.
Gardner, M. O., & Doyle, N. M. (2004). Asthma in pregnancy. Obstetrics and Gynecology Clinics of North America, 31(2),385.413. doi:10.1016/j.ogc.2004.03.010
Grindheim, G., Toska, K., Estensen, M.-E., & Rosseland, L. Changes in pulmonary function during pregnancy: a longitudinal cohort study. BJOG: An International Journal of Obstetrics & Gynaecology 2011; 119(1): 94–101.
Hanania NA, Belfort MA. Acute asthma in pregnancy. Crit Care Med 2005; 33 (10 Suppl) : 319–S324.
Hardy-Fairbanks AJ, Baker ER. Asthma in pregnancy: pathophysiology, diagnosis and management. Obstet Gynecol Clin North Am 2010; 37(2):159–172.
Hardy-Fairbanks, A. J., & Baker, E. R. (2010). Asthma in Pregnancy: Pathophysiology, Diagnosis and Management. Obstetrics and Gynecology Clinics of North America, 37(2), 159–172. doi:10.1016/j.ogc.2010.02.006.
Kwon HL, Belanger K, Bracken MB. Asthma prevalence among pregnant and childbearing-aged women in the United States: estimates from national health surveys. Ann Epidemiol 2003; 13: 317–324.
Labor, S., Dalbello Tir, A. M., Plavec, D., Juric, I., Roglic, M., Pavkov Vukelic, J., & Labor, M. What is safe enough - asthma in pregnancy - a review of current literature and recommendations. Asthma Research and Practice; 2018: 4 (1).
Liu, Xiaoqin., et al. Birth weight, gestational age, fetal growth and childhood asthma hospitalization. J Allergy, Asthma & Clinical Immunology 2014, 10:13.
LoMauro A, Aliverti A. Respiratory physiology of pregnancy. Breathe 2015;4:297-301.
Louis M, Oyiengo DO, Bourjeily G. Pulmonary disorders in pregnancy. In: Medical Management of the Pregnant Patient: A Clinician’s Handbook. 2015.
Magriples U and Copel JA. Obstetric management of the highrisk patient. In: Burrow G, Duffy T and Copel J (eds) Medical complications during pregnancy. Philadelphia: Elsevier 2004: 592.
Meng Wang, Wenbo He, Meixuan Li, Fuyun Li, Lili Jiang, Jiabin Wang, Hui Wang, Xudong Liu, Kehu Yang & Jie Qiu (2019): Maternal asthma and the risk of hypertensive disorders of pregnancy: a systematic review and meta-analysis of cohort studies, Hypertension in Pregnancy, DOI: 10.1080/10641955.2019.1693591.
Murphy, V. E. (2015). Managing asthma in pregnancy. Breathe, 11(4), 258–267. doi:10.1183/20734735.007915.
Murphy, VE. (2015) Managing asthma in pregnancy. Centre for Asthma and Respiratory Disease, University of Newcastle and Hunter Medical Research Institue, Newcastle, Australia.
NAEPP expert panel report (2005) Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. J Allergy Clin Immunol 115(1):34-46.
Nair, Pranav & Prabhavalkar, Kedar. Monitoring Asthma in Pregnancy: Diagnosis and Treatment. J Clin Pulm Med 2020;27:67–72.
Reddy Vatti, Rani & S. Teuber, Suzanne. Asthma and Pregnancy. J Clinic Rev Allerg Immunol (2012) 43:45–56.
Russell IF and Chambers WA. Closing volume in normal pregnancy. Br J Anaesth 1981; 53: 1043–1047.
Sawicki E, Stewart K, Wong S, et al. Management of asthma by pregnant women attending an Australian maternity hospital. Aust NZ J Obstet Gynaecol 2012; 52: 183–188.
Shebl E, Chakraborty RK. 2021. Asthma In Pregnancy. StatPearls Publishing LLC. https://www.ncbi.nlm.nih.gov/books/NBK532283/.
Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr 2016;2:89-94.
Urbano FL (2008) Review of the NAEPP 2007 Expert Panel Report (EPR-3) on Asthma Diagnosis and Treatment Guidelines. J Manag Care Pharm 14(1):41-49.
Vatti, R. R., & Teuber, S. S. (2011). Asthma and Pregnancy. Clinical Reviews in Allergy & Immunology, 43(1-2), 45–56. doi:10.1007/s12016-011-8277-8.
Vatti, R. R., & Teuber, S. S.. Asthma and Pregnancy. Clinical Reviews in Allergy & Immunology 2012;43(1-2), 45–56.
Wang H, Li N, Huang H. Asthma in Pregnancy: Pathophysiology, Diagnosis, Whole-Course Management, and Medication Safety. Can Respir J : 2020.
Wang, H., Li, N., & Huang, H. (2020). Asthma in Pregnancy: Pathophysiology, Diagnosis, Whole-Course Management, and Medication Safety. Canadian Respiratory Journal, 2020, 1–10. doi:10.1155/2020/9046842.
Yi Lee, Shih., et al. Dyspnea in pregnancy. Taiwanese Journal of Obstetrics & Gynecology 56 (2017) 432-436.
Published
2023-03-31
Section
Articles