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British guideline on the management of asthma in pregnancy

  • Several physiological changes occur during pregnancy which could worsen or improve asthma
  • Pregnancy can affect the course of asthma, and asthma and its treatment can affect pregnancy outcomes
  • Women should be advised of the importance of maintaining good control of their asthma during pregnancy to avoid problems for both mother and baby
  • Monitor pregnant women with moderate/severe asthma closely to keep their asthma well controlled
  • Advise women who smoke about the dangers for themselves and their babies and give appropriate support to stop smoking

Drug therapy in pregnancy

  • The following drugs should be used as normal during pregnancy:
    • short acting β2 -agonists
    • long acting β2 -agonists
    • inhaled corticosteroids
    • oral and intravenous theophyllines
  • Use steroid tablets as normal when indicated during pregnancy for severe asthma. Steroid tablets should never be withheld because of pregnancy
  • If leukotriene receptor antagonists are required to achieve adequate control of asthma then they should not be withheld during pregnancy

Acute asthma in pregnancy

  • Give drug therapy for acute asthma as for non-pregnant patients, including systemic steroids and magnesium sulphate
  • Acute severe asthma in pregnancy is an emergency and should be treated vigorously in hospital
  • Deliver high flow oxygen immediately to maintain saturation 94–98%
    • continuous fetal monitoring is recommended for acute severe asthma
    • for women with poorly controlled asthma there should be close liaison between the respiratory physician and obstetrician, with early referral to critical care physicians for women with acute severe asthma

Management during labour

  • If anaesthesia is required, regional blockade is preferable to general anaesthesia
  • Use prostaglandin F2αwith extreme caution in women with asthma because of the risk of inducing bronchoconstriction
  • Advise women:
    • that an acute asthma attack is rare in labour
    • to continue their usual asthma medications in labour
  • Women receiving steroid tablets at a dose exceeding prednisolone 7.5 mg per day for >2 weeks prior to delivery should receive parenteral hydrocortisone 100 mg 6–8 hourly during labour
  • In the absence of an acute severe asthma attack, reserve Caesarean section for the usual obstetric indications

Drug therapy in breastfeeding mothers

  • Encourage women with asthma to breastfeed
  • Use asthma medications as normal during lactation

full guidelines available from…
thorax.bmj.com/content/69/Suppl_1.toc

British Thoracic Society, Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. Thorax 2014; 69: i1–i192. October 2014.
Reproduced with kind permission from BMJ and Thorax.
First included: November 2014.