Respiratory disorders affect pregnancy; asthma is the common cause of respiratory disorders. It affects maternal and fetal outcomes when not managed properly. Pregnancy also influences the course of asthma through physiological respiratory, immune, and hormonal changes. Asthmatic exacerbations are an important feature of asthma; some may need intensive care admission. Managing critical asthma syndrome (CAS) and near-fatal asthma (NFA) remains challenging. Immediate and prompt intervention with medications and supportive care will reduce exacerbations and symptoms of asthma. The purpose of this article is to provide an overview of asthma in pregnancy and summarize the current knowledge. This review aims to create awareness among patients and physicians on the importance of managing asthma during pregnancy. To conclude, early and prompt detection of asthma and its exacerbations, optimal control of asthma, and prevention of its adverse effects will help both mother and fetus. Educating mothers on the importance of antiasthmatic therapy, avoiding triggers, and frequently monitoring symptoms are sine qua non for good asthma management.
Gluck JC, Gluck PA. The effect of pregnancy on the course of asthma. Immunol Allergy Clin North Am 2006;26(1):63–80. DOI: 10.1016/j.iac.2005.10.008
NHS RB. Management of asthma in pregnancy- Maternity Guidelines. Downloads/GPs/GP protocols and guidelines/. https://www.royalberkshire.nhs.uk/ NHS RB. https://www.royalberkshire.nhs.uk/Mater
Conte T, Bergeron C, FitzGerald JM. Asthma and pregnancy: a review of management strategies with an emphasis on medication safety and outcomes. Can J Sleep MedRespir Crit Care 2018;2(3):155–165. DOI: 10.1080/24745332.2017.1409090
Schatz M, Harden K, Forsythe A, et al. The course of asthma during pregnancy, post partum, and with successive pregnancies: a prospective analysis. J Allergy Clin Immunol 1988;81(3):509–517.
SIGN 153. British guideline on the management of asthma. Key to evidence statements and grades of recommendations. Revised edition, September 2016.
Global Initiative for asthma. Global strategy for asthma management and prevention.
Murphy VE, Namazy JA, Powell H, et al. A meta-analysis of adverse perinatal outcomes in women with asthma. BJOG 2011;118(11):1314–1323. DOI: 10.1111/j.1471-0528.2011.03055.x
Bonham CA, Patterson KC, Strek ME. Asthma outcomes and management during pregnancy. Chest 2018;153(2):515–527. DOI: 10.1016/j.chest.2017.08.029
Gluck JC. The change of asthma course during pregnancy. Clin Rev Allergy Immunol 2004;26(3):171–180. DOI: 10.1385/CRIAI:26:3:171
LoMauro A, Aliverti A. Respiratory physiology of pregnancy: physiology masterclass. Breathe 2015;11(4):297–301. DOI: 10.1183/20734735.008615
Wang H, Li N, Huang H. Asthma in pregnancy: pathophysiology, diagnosis, whole-course management, and medication safety. Can Respir J 2020;2020:9046842. DOI: 10.1155/2020/9046842
Labor S, Dalbello Tir AM, Plavec D, et al. What is safe enough – asthma in pregnancy – a review of current literature and recommendations. Asthma Res Pract 2018;4:11. DOI: 10.1186/s40733-018-0046-5
Murphy VE, Gibson P, Talbot PI, et al. Severe asthma exacerbations during pregnancy. Obstet Gynecol 2005;106(5 Pt 1):1046–1054. DOI: 10.1097/01.AOG.0000185281.21716.02
Baghlaf H, Spence AR, Czuzoj-Shulman N, et al. Pregnancy outcomes among women with asthma. J Matern Fetal Neonatal Med 2019;32(8):1325–1331. DOI: 10.1080/14767058.2017.1404982
Mendola P, Laughon SK, Männistö TI, et al. Obstetric complications among US women with asthma. Am J Obstet Gynecol. 2013;2:127
Stenius-Aarniala BS, Hedman J, Teramo KA. Acute asthma during pregnancy. Thorax 1996;51(4):411–414. DOI: 10.1136/thx.51.4.411
Stevens DR, Perkins N, Chen Z, et al. Determining the clinical course of asthma in pregnancy. J Allergy Clin Immunol Pract 2022;10(3): 793–802.e10. DOI: 10.1016/j.jaip.2021.09.048
Robijn AL, Jensen ME, McLaughlin K, et al. Inhaled corticosteroid use during pregnancy among women with asthma: a systematic review and meta-analysis. Clin Exp Allergy 2019;49(11):1403–1417. DOI: 10.1111/cea.13474
Society/SIGN British guideline for management of asthma. Sign 158. 2019. pp. 1–28.
Australia. NAC. Asthma management handbook version 2.1.
Burgess L, McCaf fery K, Powell H, et al. The inf luence of asthma control on psychosocial outcomes for pregnant women with asthma. J Asthma 2015;52(10):1013–1019. DOI: 10.3109/02770903.2015.1038833
Namazy JA, Schatz M. Management of asthma during pregnancy: optimizing outcomes and minimizing risk. Semin Respir Crit Care Med 2018;39(1):29–35. DOI: 10.1055/s-0037-1606216
McCallister JW. Asthma in pregnancy: management strategies. Curr Opin Pulm Med 2013;19(1):13–17. DOI: 10.1097/MCP.0b013e32835a5bf3
National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program Asthma and Pregnancy Working Group. NAEPP expert panel report. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. J Allergy Clin Immunol 2005;115(1):34–46. DOI: 10.1016/j. jaci.2004.10.023
George R, Berkenbosch JW, Tobias JD, et al. Mechanical ventilation during pregnancy using a helium-oxygen mixture in a patient with respiratory failure due to status asthmaticus. J Perinatol 2001;21(6):395–398. DOI: 10.1038/sj.jp.7210530
Hanania NA, Belfort MA. Acute asthma in pregnancy. Crit Care Med 2005;33(10):S319–S324. DOI: 10.1097/01.CCM.0000182789.14710.A1
Elliot SC, Paramasivam K, Oram J, et al. Pumpless extracorporeal carbon dioxide removal for life threatening asthma. Crit Care Med 2007;35(3):945–948. DOI: 10.1097/01.CCM.0000257462.04514.15
Wikner BN, Stiller CO, Bergman U, et al. Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: neonatal outcome and congenital malformations. Pharmacoepidemiol Drug Saf 2007;16(11):1203–1210. DOI: 10.1002/pds.1457
Louie S, Morrissey BM, Kenyon NJ, et al. The critically ill asthmatic–from ICU to discharge. Clin Rev Allergy Immunol 2012;43(1-2):30–44. DOI: 10.1007/s12016-011-8274-y
Elsayegh D, Shapiro JM. Management of the obstetric patient with status asthmaticus. J Intensive Care Med 2008;23(6):396–402. DOI: 10.1177/0885066608324295
Nair A, Sriprakash K. Dexmedetomidine in pregnancy: review of literature and possible use. J Obstet Anaesth Crit Care 2013.
Enriquez R, Wu P, Griffin MR, et al. Cessation of asthma medication in early pregnancy. Am J Obstet Gynecol 2006;195(1):149–153. DOI: 10.1016/j.ajog.2006.01.065
Ramachandran R, Karthika M, Nair SG. Extracorporeal membrane oxygenation-a bridge to life in COVID-19 complicated pregnancy. Indian J Respir Care 2022;11(3):270–273. DOI: 10.4103/ijrc.ijrc_59_22
Bandoli G, Palmsten K, Forbess Smith CJ, et al. A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes. Rheum Dis Clin North Am 2017;43(3):489–502. DOI: 10.1016/j.rdc.2017.04.013
Rey A, Jassem E, Chelminska M. Evaluation of asthma course in pregnancy. Ginekol Pol 2019;90(8):464–469. DOI: 10.5603/GP.2019.0080
Lim AS, Stewart K, Abramson MJ, et al. Multidisciplinary approach to management of maternal asthma (MAMMA): a randomized controlled trial. Chest 2014;145(5):1046–1054. DOI: 10.1378/chest.13-2276