Asthma Should Be Treated Aggressively in Pregnancy

Laurie Barclay, MD

May 21, 2002

NEW YORK (Medscape Wire) May 22 -- National guidelines recommend that pregnant women be aggressively treated for asthma. But 2 studies presented on May 20 at the American Thoracic Society annual meeting suggest that they are not, due in part to doctors' reluctance to use steroids in pregnant women.

"A dramatic increase in the prevalence of asthma over the past decade has made asthma the most common chronic disease during pregnancy, affecting approximately 10% of women," write K. Belanger and colleagues from the Yale University School of Medicine in New Haven, Connecticut. "Because of the potential risk of asthma exacerbation to both mother and fetus, the National Asthma Education Program (NAEP/NHLBI) has issued guidelines for the treatment of asthma during pregnancy."

In an ethnically diverse sample of 761 pregnant asthmatics in Connecticut and southwestern Massachusetts, 255 women (33%) had severe, 182 women (24%) had moderate, and 324 women (43%) had mild asthma for 3 or more months of pregnancy. Medication use included beta-agonists in 23% and anti-inflammatory drugs in 11%.

In comparison with the NAEP guidelines, 497 women (65%) were undertreated for 3 or more months of pregnancy, including 40% of mild, 86% of moderate, and 83% of severe asthmatics. Among mild asthmatics, clinic patients were 50% less likely to be undertreated, but severe asthmatics were 3 times as likely to be undertreated.

"Pregnant asthmatics are not being treated according to the NAEP guidelines," the authors write. "The health of these women and their infants may be at risk."

In a separate study from the University of Chicago, only 46% of pregnant asthmatics admitted to the intensive care unit received inhaled steroids as outpatients, even though 96% were using inhaled bronchodilators. Of the 26 women, 1 died, 10 were intubated, and 9 received neuromuscular blockade.

"Current NIH recommendations are that outpatients with moderate-to-severe persistent asthma be treated with albuterol and inhaled corticosteroids; inpatients should be treated with albuterol and systemic steroids," write S. Skjei and colleagues. "Despite this, physicians may be reluctant to treat asthma aggressively, fearing toxicity to the fetus."

Of 12 deliveries during hospitalization, there were only 8 live births, and 4 infants needed to be intubated. Mean gestational age was 29.3 weeks and mean birth weight 1700 grams. Apgar scores at 1 and 5 minutes were 4.3 (SD=3.6) and 7.0 (1.5-8.8).

"Consequences of severe uncontrolled asthma in pregnancy may be dire," the authors write. "These data confirm that severe asthma exacerbation is associated with significant morbidity for mother and fetus. Low relative use of inhaled corticosteroids identifies a potential target for intervention."

ATS Annual Meeting: Abstracts 109133,122634. Presented May 20, 2002.

Reviewed by Gary D. Vogin, MD

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