Treating asthma and comorbid allergic rhinitis in pregnancy

Women with severe or uncontrolled asthma are at higher risk for pregnancy complications and adverse fetal outcomes than women with well-controlled asthma. Recent evidence-based guidelines have concluded that it is safer for pregnant women with asthma to be treated pharmacologically than to continue to have asthma symptoms and exacerbations. According to the Asthma and Pregnancy Working Group (APWG) of the National Asthma Education and Prevention Program, optimal treatment of asthma during pregnancy includes treatment of comorbid allergic rhinitis (AR), which can trigger or aggravate asthma symptoms. In general, treatment of both asthma and AR during pregnancy should follow the same stepwise approach that is used in the general population. This article presents the specific recommendations from the most recent APWG report and from other systematic reviews about which asthma and allergic rhinitis drugs should be preferred during pregnancy. Of the corticosteroids, budesonide has the most data and is listed as Pregnancy Category B (no evidence of risk in humans). Other inhaled and intranasal corticosteroids have less data and are listed as Pregnancy Category C but may be continued during pregnancy if the patient's asthma was well controlled with the medication before pregnancy. Family physicians should help their patients control allergic rhinitis and asthma during pregnancy, encouraging adherence to needed medications.