Monitoring and managing asthma important for healthy mother and baby
The National Asthma Education and Prevention Program (NAEPP) is issuing the first new guidelines in more than a decade for managing asthma during pregnancy. The report reflects new medications that have emerged and updates treatment recommendations for pregnant women with asthma based on a systematic review of data on the safety of asthma medications during pregnancy. An executive summary ("Quick Reference") of the guidelines is published in the January issue of the Journal of Allergy & Clinical Immunology.
Poorly controlled asthma can lead to serious medical problems for pregnant women and their fetuses. The guidelines emphasize that controlling asthma during pregnancy is important for the health and well-being of the mother as well as for the healthy development of the fetus. A stepwise approach to asthma care similar to that used in the NAEPP general asthma treatment guidelines for children and nonpregnant adults is recommended. Under this approach, medication is stepped up in intensity if needed, and stepped down when possible, depending on asthma severity. Because asthma severity changes during pregnancy for most women, the guidelines also recommend that clinicians who provide obstetric care monitor asthma severity during prenatal visits of their patients who have asthma.
"Several studies have shown that taking inhaled corticosteroids improves lung function during pregnancy and reduces asthma exacerbations--and other large, prospective studies found no relation between taking inhaled corticosteroids and congenital abnormalities or other adverse pregnancy outcomes," said Michael Schatz, M.D., M.S., chief of the Department of Allergy for Kaiser Permanente San Diego Medical Center. Schatz is also a member of the NAEPP expert panel on asthma during pregnancy and author of an editorial accompanying the guidelines report.
The guidelines highlight other important aspects of asthma management during pregnancy, such as identifying and limiting exposure to asthma triggers. Similarly, women with other conditions that can worsen asthma, such as allergic rhinitis, sinusitis, and gastroesophageal reflux, should have those conditions treated as well. Such conditions often become more troublesome during pregnancy.
"As important as medications are for controlling asthma, a pregnant woman can reduce how much medication is needed by identifying and avoiding the factors that make her asthma worse, such as tobacco smoke or allergens like dust mites," added Dr. Schatz.
The NAEPP was established in March 1989 to reduce asthma-related illness and death and to enhance the quality of life of people with asthma. Today, 40 organizations, including major medical associations, voluntary health organizations, and numerous federal agencies, comprise the NAEPP Coordinating Committee. The NAEPP also coordinates federal asthma-related activities, as designated by Congress through the Childrens Health Act of 2000. NAEPP convenes expert panels as needed to ensure that the latest scientific evidence is translated into clinical recommendations to help clinicians provide the best possible asthma care.
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