Optimum management of asthma in pregnancy

In pregnancy complicated by asthma, the greatest risk to the fetus is severe and uncontrolled bronchospasm resulting in hypoxia. For this reason, the priority in management of the pregnant asthmatic should be effective control of asthma symptoms with an appropriate amount of asthma medication to accomplish this goal. In general, the management of the pregnant asthmatic does not differ greatly from that of the non-pregnant asthmatic. Virtually none of the commonly used asthma medications are totally contraindicated in pregnancy if their use is justified by the severity of the asthma in pregnancy. These include optimising non-pharmacological means of controlling symptoms, using the smallest doses of antiasthma drugs necessary to control symptoms, basing the decision to use a drug on its benefit-to-risk ratio, avoiding recently introduced drugs (for which safety in pregnancy has not been adequately established), and using the inhaled route in preference to the oral route of administration. Ideally any changes in management should be made before the anticipated pregnancy. Well-controlled asthma appears to pose little risk to either the pregnant mother or the fetus and a favourable outcome of the pregnancy should be anticipated. The patient's justifiable anxiety can often be alleviated by ensuring that she fully understands the objectives of her management and participates in it.