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Asthma: Management

  • Jennifer A. Namazy
Chapter

Abstract

Asthma is one of the most common potentially serious medical problems to complicate pregnancy. Optimal management of asthma during pregnancy is thus important for both mother and baby. Treating asthmatic women requires understanding the effects of pregnancy on the course of asthma and, conversely, the effects of asthma on pregnancy outcomes. Successful management also requires understanding the barriers to asthma control in this population of patients. It is essential that the allergist-immunologist, obstetrician, and patient work as a team during pregnancy to achieve optimal maternal and neonatal outcomes.

Keywords

Asthma Pregnancy Perinatal outcomes Pregnancy complications 

References

  1. 1.
    Kwon HL, Belanger K, Bracken MB. Asthma prevalence among pregnant and childbearing-aged women in the United States: estimates from national health surveys. Ann Epidemiol. 2003;13(5):317–24.CrossRefGoogle Scholar
  2. 2.
    Charlton RA, Hutchison A, Davis KJ, de Vries CS. Asthma management in pregnancy. PLoS One. 2013;8(4):e60247.CrossRefGoogle Scholar
  3. 3.
    Belanger K, Hellenbrand M, Holford T, Bracken M. Effect of pregnancy on maternal asthma symptoms and medication use. Obstet Gynecol. 2010;115:559–67.CrossRefGoogle Scholar
  4. 4.
    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;81:509–17.CrossRefGoogle Scholar
  5. 5.
    Murphy V, Namazy J, Powell H, Schatz M, Chambers C, Attia J, et al. A meta-analysis of adverse perinatal outcomes in women with asthma. Br J Obstet Gynaecol. 2011;118(11):1314–23.CrossRefGoogle Scholar
  6. 6.
    Murphy VE, Wang G, Namazy JA, Powell H, Gibson PG, Chambers C, et al. The risk of congenital malformations, perinatal mortality and neonatal hospitalisation among pregnant women with asthma: a systematic review and meta-analysis. BJOG Int J Obstet Gynaecol. 2013;120(7):812–22.CrossRefGoogle Scholar
  7. 7.
    Rejno G, Lundholm C, Gong T, et al. Asthma during pregnancy in a population-based study – pregnancy complications and adverse perinatal outcomes. PLoS One. 2014;9:e104755.CrossRefGoogle Scholar
  8. 8.
    Namazy J, Murphy V, Powell H, Gibson P, Chambers C, Schatz M. Effects of asthma severity, exacerbations and oral corticosteroids on perinatal outcomes. Eur Respir J. 2012;41:1082–90.CrossRefGoogle Scholar
  9. 9.
    Murphy VE, Clifton VL, Gibson PG. Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes. Thorax. 2006;61(2):169–76.CrossRefGoogle Scholar
  10. 10.
    Firoozi F, Lemiere C, Ducharme FM, Beauchesne MF, Perreault S, Berard A, et al. Effect of maternal moderate to severe asthma on perinatal outcomes. Respir Med. 2010;104(9):1278–87.CrossRefGoogle Scholar
  11. 11.
    Dombrowski MP, Schatz M, Wise R, Momirova V, Landon M, Mabie W, et al. Asthma during pregnancy. Obstet Gynecol. 2004;103(1):5–12.CrossRefGoogle Scholar
  12. 12.
    Stenius-Aarniala BS, Hedman J, Teramo KA. Acute asthma during pregnancy. Thorax. 1996;51(4):411–4.CrossRefGoogle Scholar
  13. 13.
    Blais L, Forget A. Asthma exacerbations during the first trimester of pregnancy and the risk of congenital malformations among asthmatic women. J Allergy Clin Immunol. 2008;121(6):1379–84,84 e1.CrossRefGoogle Scholar
  14. 14.
    Murphy VE, Gibson P, Talbot PI, Clifton VL. Severe asthma exacerbations during pregnancy. Obstet Gynecol. 2005;106(5 Pt 1):1046–54.CrossRefGoogle Scholar
  15. 15.
    Jana N, Vasishta K, Saha SC, Khunnu B. Effect of bronchial asthma on the course of pregnancy, labour and perinatal outcome. J Obstet Gynaecol (Tokyo 1995). 1995;21(3):227–32.CrossRefGoogle Scholar
  16. 16.
    Greenberger PA, Patterson R. The outcome of pregnancy complicated by severe asthma. Allergy Proc. 1988;9(5):539–43.CrossRefGoogle Scholar
  17. 17.
    Breton M-C, Beauchesne M-F, Lemiere C, Rey E, Forget A, Blais L. Risk of perinatal mortality associated with asthma during pregnancy. Thorax. 2009;64(2):101–6.CrossRefGoogle Scholar
  18. 18.
    Breton M, Beauchesne MF, Lemiere C, Rey E, Forget A, Blais L. Risk of perinatal mortality associated with asthma during pregnancy: 2-stage sampling cohort study. Ann Allergy Asthma Immunol. 2010;105(3):211–7.CrossRefGoogle Scholar
  19. 19.
    Triche EW, Saftlas AF, Belanger K, Leaderer BP, Bracken MB. Association of asthma diagnosis, severity, symptoms, and treatment with risk of preeclampsia. Obstet Gynecol. 2004;104(3):585–93.CrossRefGoogle Scholar
  20. 20.
    Schatz M, Dombrowski MP, Wise R, Momirova V, Landon M, Mabie W, et al. Spirometry is related to perinatal outcomes in pregnant women with asthma. Am J Obstet Gynecol. 2006;194(1):120–6.CrossRefGoogle Scholar
  21. 21.
    Rudra CB, Williams MA, Frederick IO, Luthy DA. Maternal asthma and risk of preeclampsia: a case-control study. J Reprod Med. 2006;51(2):94–100.PubMedGoogle Scholar
  22. 22.
    Tata LJ, Lewis SA, McKeever TM, Smith CJ, Doyle P, Smeeth L, et al. A comprehensive analysis of adverse obstetric and pediatric complications in women with asthma. Am J Respir Crit Care Med. 2007;175(10):991–7.CrossRefGoogle Scholar
  23. 23.
    Siddiqui S, Goodman N, McKenna S, Goldie M, Waugh J, Brightling CE. Pre-eclampsia is associated with airway hyperresponsiveness. BJOG. 2008;115:520–2.CrossRefGoogle Scholar
  24. 24.
    Clifton VL, Giles WB, Smith R, Bisits AT, Hempenstall PA, Kessell CG, et al. Alterations of placental vascular function in asthmatic pregnancies. Am J Respir Crit Care Med. 2001;164(4):546–53.CrossRefGoogle Scholar
  25. 25.
    Read M, Leitch I, Giles W, Bisits A, Boura A, Walters W. U46619-mediated vasoconstriction of the fetal placental vasculature in vitro in normal and hypertensive pregnancies. J Hypertens. 1999;17(3):389–96.CrossRefGoogle Scholar
  26. 26.
    Bracken MB, Triche EW, Belanger K, Saftlas A, Beckett WS, Leaderer BP. Asthma symptoms, severity, and drug therapy: a prospective study of effects on 2205 pregnancies. Obstet Gynecol. 2003;102(4):739–52.PubMedGoogle Scholar
  27. 27.
    Blais L, Kettani FZ, Forget A. Relationship between maternal asthma, its severity and control and abortion. Hum Reprod. 2013;28:908–15.CrossRefGoogle Scholar
  28. 28.
    Blais L, Kettani FZ, Forget A, Beauchesne MF, Lemiere C. Asthma exacerbations during the first trimester of pregnancy and congenital malformations: revisiting the association in a large representative cohort. Thorax. 2015;70:647–52.CrossRefGoogle Scholar
  29. 29.
    Ali Z, Nilas L, Ulrik CS. Postpartum airway responsiveness and exacerbation of asthma during pregnancy – a pilot study. J Asthma Allergy. 2017;10:261–7.CrossRefGoogle Scholar
  30. 30.
    Eszes N, Toldi G, Bohacs A, Muller V, Rigo JJ, Losonczy G, et al. Relationship of circulating hyaluronic acid levels to disease control in asthma and asthmatic pregnancy. PLoS One. 2014;15(9):e94678.CrossRefGoogle Scholar
  31. 31.
    Dombai B, Ivancso I, Bikov A, Oroszi D, Bohacs A, Muller V, et al. Circulating clusterin and osteopontin levels in asthma and asthmatic pregnancy. Can Respir J. 2017:1602039.  https://doi.org/10.1155/2017/1602039.CrossRefGoogle Scholar
  32. 32.
    Tamasi L, Somoskovi A, Muller V, Bartfai Z, Acs N, Puho E, et al. A population-based case-control study on the effect of bronchial asthma during pregnancy for congenital abnormalities of the offspring. J Asthma. 2006;43(1):81–6.CrossRefGoogle Scholar
  33. 33.
    Powell H, Murphy VE, Taylor DR, Hensley MJ, McCaffrey K, Giles W, et al. Management of asthma in pregnancy guided by measurement of fraction of exhaled nitric oxide: a double-blind, randomised controlled trial. Lancet. 2011;378(9795):983–90.CrossRefGoogle Scholar
  34. 34.
    Palmsten K, Schatz M, Chan PH, et al. Validation of the pregnancy asthma control test. J Allergy Clin Immunol. J Allergy Clin Immunol Pract. 2016;4(2):310–5.e1. https://doi.org/10.1016/j.jaip.2015.11.019. Epub 2016 Jan 5.Google Scholar
  35. 35.
    Amaral L, Martins C, Coimbra A. Use of control of allergic rhinitis and asthma test and pulmonary function tests to assess asthma control in pregnancy. Aust N Z J Obstet Gynaecol. 2018;58(1):86–90.CrossRefGoogle Scholar
  36. 36.
    Koo SM, Kim Y, Park C, Park GW, Lee M, Won S, et al. Effect of pregnancy on quantitative medication use and relation to exacerbations in asthma. Biomed Res Int. 2017:8276190.  https://doi.org/10.1155/2017/8276190. Epub 2017 Jul 20.CrossRefGoogle Scholar
  37. 37.
    Sawicki E, Stewart K, Wong S, Paul E, Leung L, George J. Management of asthma by pregnant women attending an Australian maternity hospital. Aust N Z J Obstet Gynaecol. 2012;52(2):183–8.CrossRefGoogle Scholar
  38. 38.
    Lim AS, Stewart K, Abramson MJ, Ryan K, George J. Asthma during pregnancy: the experiences, concerns and views of pregnant women with asthma. J Asthma. 2012;49(5):474–9.CrossRefGoogle Scholar
  39. 39.
    Lim A, Stewart K, Abramson M, George J. Management of pregnant women with asthma by Australian general practitioners. BMC Fam Pract. 2011;12:121.CrossRefGoogle Scholar
  40. 40.
    Cimbollek S, Plaza V, Quirce S, Costa R, Urrutia I, Ojeda P, et al. Knowledge, attitude and adherence of Spanish healthcare professionals to asthma management recommendations during pregnancy. Allergol Immunopathol (Madr). 2012;41:114–20.CrossRefGoogle Scholar
  41. 41.
    Cydulka R, Emerman C, Schreiber D, Molander K, Woodruff P, Camargo C. Acute asthma among pregnant women presenting to the emergency department. Am J Respir Crit Care Med. 1999;160:887–92.CrossRefGoogle Scholar
  42. 42.
    McCallister J, Benninger C, Frey H, Phillips G, Mastronarde J. Pregnancy related treatment disparities of acute asthma exacerbations in the emergency department. Respir Med. 2011;105:1434–40.CrossRefGoogle Scholar
  43. 43.
    Lim AS, Stewart K, Abramson MJ, Walker S, Smith CL, George J. Multidisciplinary approach to management of MAternal ASthma (MAMMA): a randomized controlled trial. Chest. 2014;145(5):1046–54.CrossRefGoogle Scholar
  44. 44.
    Ali Z, Ulrik CS. Incidence and risk factors for exacerbations of asthma during pregnancy. J Asthma Allergy. 2013;6:53–60.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Sorri M, Hartikainen A, Karja I. Rhinitis during pregnancy. Rhinology. 1980;18(2):83–6.PubMedGoogle Scholar
  46. 46.
    Munn M, Groome L, Atterbury J. Pneumonia as a complication of pregnancy. J Matern Fetal Med. 1999;8:151–4.PubMedGoogle Scholar
  47. 47.
    Murphy VE, Powell H, Wark PAB, Gibson P. A prospective study of respiratory viral infection in pregnant women with and without asthma. Chest. 2013;144(2):420–7.CrossRefGoogle Scholar
  48. 48.
    Namazy J, Schatz M, Yang SJ, Chen W. Antibiotics for respiratory infections during pregnancy: prevalence and risk factors. J Allergy Clin Immunol Pract. 2016;4(6):1256–7.CrossRefGoogle Scholar
  49. 49.
    Schatz M, Dombrowski M. Obstet Gynecol. 2008;111:457–64.CrossRefGoogle Scholar
  50. 50.
    Schatz M, Dombrowski MP. Asthma in pregnancy. N Engl J Med. 2009;360:1862–9.CrossRefGoogle Scholar
  51. 51.
    Schatz M, Chambers C, Macy E, Zeiger RS. Chapter 56: Asthma and allergic diseases during pregnancy. In: Middleton’s allergy. Saunders, United States. 2017.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jennifer A. Namazy
    • 1
  1. 1.Division of Allergy, Asthma and ImmunologyScripps ClinicSan DiegoUSA

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