Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

New treatment guidelines for pregnant women with asthma

11.01.2005


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.


"The guidelines review the evidence on asthma medications used by pregnant patients," said Barbara Alving, M.D., acting director of the National Heart, Lung, and Blood Institute (NHLBI), which administers the NAEPP. "The evidence is reassuring, and suggests that it is safer to take medications than to have asthma exacerbations. The guidelines should be a useful tool for physicians to develop optimal asthma management plans for pregnant women."

"Simply put, when a pregnant patient has trouble breathing, her fetus also has trouble getting the oxygen it needs," added William W. Busse, M.D., professor of medicine at the University of Wisconsin Medical School, and chair of the NAEPP multidisciplinary expert panel that developed the guidelines. "There are many ways we can help pregnant women control their asthma, and it is imperative that providers and their patients work together to do so."

Asthma affects over 20 million Americans and is one of the most common potentially serious medical conditions to complicate pregnancy. Maternal asthma is associated with increased risk of infant death, preeclampsia (a serious condition marked by high blood pressure, which can cause seizures in the mother or fetus), premature birth, and low-birth weight. These risks are linked to asthma severity – more severe asthma increases risk, while better controlled asthma is tied to decreased risks.

Asthma worsens in approximately 30 percent of women who have mild asthma at the beginning of their pregnancy, according to a recent study by the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network and cofunded by NHLBI. The study also found that, conversely, asthma improved in 23 percent of the women who initially had moderate or severe asthma.

"We cannot predict who will worsen during pregnancy, so the new guidelines recommend that pregnant patients with persistent asthma have their asthma checked at least monthly by a healthcare provider," explained Mitchell Dombrowski, M.D., chief of obstetrics and gynecology for St. John Hospital in Detroit, and a member of the NAEPP expert panel. "Clinicians who provide obstetric care should be part of the patient’s asthma management team, working with the patient and her asthma care provider to adjust her medications if needed to keep her asthma under control and to lower the risk of complications from asthma for her and her baby."

Key recommendations from the guidelines regarding medications include:

  • Albuterol, a short-acting inhaled beta2-agonist, should be used as a quick-relief medication to treat asthma symptoms. Pregnant women with asthma should have this medication available at all times.
  • Women who have symptoms at least two days a week or two nights a month have persistent asthma and need daily medication for long-term care of their asthma and to prevent exacerbations. Inhaled corticosteroids are the preferred medication to control the underlying inflammation in pregnant women with persistent asthma. The guidelines note that there are more data on the safety of budesonide use during pregnancy than on other inhaled corticosteroids; however, there are no data indicating that other inhaled corticosteroids are unsafe during pregnancy, and other inhaled corticosteroids may be continued if they effectively control a patient’s asthma. Alternative daily medications are leukotriene receptor antagonists, cromolyn, or theophylline.
  • For patients whose persistent asthma is not well controlled on low doses of inhaled corticosteroids alone, the guidelines recommend either increasing the dose of inhaled corticosteroid or adding another medication -- a long-acting beta agonist. The expert panel concluded that data are insufficient to indicate a preference of one option over the other.
  • Oral corticosteroids may be required for the treatment of severe asthma. The guidelines note that there are conflicting data regarding the safety of oral corticiosteroids during pregnancy; however, severe, uncontrolled asthma poses a definite risk to the mother and fetus; and use of oral corticosteroids may be warranted.

"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 Children’s 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.

NHLBI Communications Office | EurekAlert!
Further information:
http://www.nhlbi.nih.gov

More articles from Health and Medicine:

nachricht The end of pneumonia? New vaccine offers hope
23.10.2017 | University at Buffalo

nachricht Scientists track ovarian cancers to site of origin: Fallopian tubes
23.10.2017 | Johns Hopkins Medicine

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Salmonella as a tumour medication

HZI researchers developed a bacterial strain that can be used in cancer therapy

Salmonellae are dangerous pathogens that enter the body via contaminated food and can cause severe infections. But these bacteria are also known to target...

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

3rd Symposium on Driving Simulation

23.10.2017 | Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

 
Latest News

Microfluidics probe 'cholesterol' of the oil industry

23.10.2017 | Life Sciences

Gamma rays will reach beyond the limits of light

23.10.2017 | Physics and Astronomy

The end of pneumonia? New vaccine offers hope

23.10.2017 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>