The management of asthma during pregnancy and lactation

The optimal management of asthma during pregnancy and lactation requires a cooperative approach between the physician managing asthma, the obstetrician-gynecologist, and the patient. Goals of therapy include: 1) avoidance of repeated episodes of asthma, 2) avoidance of emergency room visits, 3) avoidance of status asthmaticus, 4) prevention of death in the mother, 5) use of minimal medications in the gravida, and 6) avoidance of maternal medication use with uncertain or deleterious effects on the fetus. Because acute severe asthma may have it onset during pregnancy, the physician must be prepared to diagnose and treat the gravida to avoid or reduce episodes of maternal hypoxemia, hypocarbia or hypercarbia. Status asthmaticus has been associated with maternal and fetal deaths as well as intrauterine growth retardation. Although it is logical to assume that prevention of repeated episodes of asthma would be associated with a more favorable outcome in pregnancy, only recently was this actually documented. The purpose of this manuscript is to review issues in diagnosis and management of asthma during pregnancy and lactation.