Pregnant mothers' small class | When you encounter asthma during pregnancy, you must know these "medicines"...

Nurturing a life is such a wonderful thing, but for expectant mothers with asthma, they can't help but worry that the medication will affect the fetus. Some expectant mothers will even secretly reduce or stop taking the medication.

In fact, asthma is one of the most common diseases during pregnancy, affecting about 4% to 8% of pregnant women. The changes in asthma symptoms during pregnancy are unpredictable: 1/3 of patients will experience worsening asthma symptoms during pregnancy, 1/3 will see improvement, and the remaining 1/3 will remain unchanged.

It should be pointed out that due to endocrine and mechanical factors after pregnancy, especially in the second trimester (24th to 36th week of pregnancy), asthma may worsen or have acute attacks. Pregnant women may also be induced to asthma by respiratory virus infection.

Asthma can affect pregnancy outcomes, and the extent of the impact depends on whether asthma attacks can be effectively controlled. In particular, the risk of perinatal death, preeclampsia, and premature birth is 15% to 20% higher for pregnant women with asthma than for women without asthma. However, these risks only occur when the condition is poorly controlled.

Therefore, to deal with asthma during pregnancy, we must take precautions before it happens and take the initiative.

Implement full-process management

Implementing comprehensive management of asthma during pregnancy is to reduce fluctuations in asthma symptoms or acute attacks, and reduce the negative impact on pregnant women and fetuses.

First, we need to evaluate and monitor changes in asthma during pregnancy and monitor the variability of peak expiratory flow (PEF). During prenatal checkups, doctors should make comprehensive assessments based on medical history and results and scientifically adjust treatment plans. Pharmacists should evaluate and correct the correct use of inhalers and monitor asthma symptom control in pregnant women through phone calls, WeChat, and other means.

Secondly, we should control the factors that aggravate asthma and avoid exposure to triggering factors. Smoking is prohibited, and second-hand smoke is avoided. The environment should be kept clean and the temperature and humidity should be kept appropriate. Going out should be reduced appropriately to avoid respiratory infections. Actively treat diseases such as allergic rhinitis, sinusitis, and gastroesophageal reflux.

Third, it is important to recognize acute attacks of pregnancy asthma. Once symptoms such as cough, chest tightness, shortness of breath, wheezing, or a 20% decrease in PEF and a decrease in fetal movement occur, you should immediately inhale 2 to 4 sprays/presses of salbutamol aerosol every 20 minutes and observe for 1 hour. If the symptoms do not improve, you should seek medical attention immediately.

Finally, expectant mothers should strengthen self-management. They should learn popular science knowledge through videos, the Internet, and apps, understand scientific medication knowledge, and realize self-monitoring of their condition and medication management.

Must be considered for safety

The treatment principles for asthma during pregnancy are the same as those for common asthma. At the same time, "safety" should be taken into consideration. Try to choose old medicines with a "good record" and keep the dosage to the lowest level when conditions permit.

Currently, none of the existing asthma drugs meet the Class A standard of the U.S. Food and Drug Administration (FDA) for drug safety during pregnancy. In other words, no drug is absolutely safe. During pregnancy, the use of any drug may have adverse effects on the mother and fetus. However, it must be pointed out that evidence-based evidence shows that the benefits of actively controlling asthma and preventing attacks far outweigh the potential risks of these drugs.

There are "tricks" to drug selection

So, what kind of medicine should be used for asthma during pregnancy?

1. Inhaled corticosteroids (ICS) and short-acting β2 receptor agonists are the first-line drugs for asthma during pregnancy. Inhaled administration not only acts directly on the airways to quickly exert its effects, but also minimizes the amount of drug entering the maternal circulation, reducing the possibility of passing it to the fetus through the placenta.

2. Budesonide has a better reputation for safety during pregnancy and can be used first. More and more evidence shows that ICS can reduce asthma attacks during pregnancy, but stopping it may lead to worsening of asthma. Here we remind expectant mothers to use ICS correctly according to the doctor's instructions and never stop taking it at will.

3. For the treatment of acute attacks of bronchial asthma, short-acting β2 receptor agonists are the first choice and are relatively safe to use during pregnancy. The American College of Obstetricians and Gynecologists and the American Asthma Education and Prevention Program recommend salbutamol (inhaled) as the first choice and suggest that you carry this medicine with you to prevent acute attacks of asthma. If the expectant mother has been using long-acting β2 receptor agonists (LABA combined with ICS) to control asthma before pregnancy, there is no need to change and she can continue to use it.

4. Leukotriene receptor antagonists are alternative treatments for mild asthma and are not the first choice. If the treatment response before pregnancy is good, they can continue to be used.

To sum up, whether it is ICS (such as budesonide, beclomethasone dipropionate, fluticasone, etc.), β2 receptor agonists (such as salbutamol, terbutaline, formoterol, salmeterol, etc.), or leukotriene receptor modulators (such as montelukast) and theophylline, they are relatively safe to use during pregnancy and will not increase the probability of fetal abnormalities.

In fact, obesity and weight gain during pregnancy, anxiety about diseases and the fetus, and postpartum stress may all trigger asthma attacks or worsen. Therefore, expectant mothers should have a balanced diet, relax, and eliminate their worries. As long as they master these "medicine" points, standardize treatment, and manage scientifically, I believe that expectant mothers with asthma will definitely get through pregnancy safely and give birth to healthy babies.

Author: Guo Tiejian, clinical pharmacist, Dalian Women and Children's Medical Center (Group)

Review expert: Li Ling, chief pharmacist of Dalian Women and Children's Medical Center (Group)

Wei Guoyi, Chief Pharmacist, Beijing Anzhen Hospital, Capital Medical University