Asthma is the most common respiratory disease that can complicate pregnancy. Having control of asthma during pregnancy is important to ensure good maternal and foetal outcomes. On this World Asthma Day, Dr Nagarjuna Maturu V, Senior Consultant, Clinical and Interventional Pulmonology, Yashoda Hospitals, Hyderabad, explains the correct way to manage it.
Will My Asthma Symptoms Worsen During Pregnancy?
Dr Maturu said, "Not all asthmatics will have worsening asthma symptoms during pregnancy." He added that asthma symptoms improve in one-third of pregnant women with asthma. In another one-third of asthmatic women, the symptoms remain unchanged, and in the remaining one-third, asthma worsens during pregnancy. He said, "A small number of women can also have a new onset of asthma during pregnancy. Also, those who have poor asthma control before conception are more likely to have asthma attacks during pregnancy."
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What are the Harmful Maternal and Foetal Effects of Poor Maternal Asthma Control?
Dr Maturu said, "Mothers with poor asthma control are likely to have a higher chance of pre-term delivery, caesarian section, gestational hypertension, and diabetes. Further, if they develop viral respiratory infections during pregnancy, they are likely to have more severe disease." Poor maternal asthma control can also lead to the foetus receiving lower oxygen, which leads to intra-uterine growth retardation, according to the doctor. "The children are likely to be small for gestational age and stand a higher chance of developing childhood allergies," he added.
Steps to Keep Asthma in Control During Pregnancy
Pre-Conception Care for Asthmatic Women
The management of asthma during pregnancy starts from the pre-conception phase itself. Women with asthma who plan to conceive should consult their asthma or allergy specialist and have a written plan for the pregnancy. It is important to ensure that asthma remains well-controlled for at least three months before conception. Losing weight before conception will also help improve maternal outcomes in women who are overweight.
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Don't Discontinue Asthma Medicines During Pregnancy
Many women abruptly stop medicines after conception for fear that the medicines can harm the growing foetus. Inhalers are one of the choices for the treatment of asthma, and all medicines that need to be inhaled are safe for the mother and the foetus, according to the expert. The mother needs to take the inhaler using the correct technique (each inhaler has a different technique for usage) and to gargle the mouth and throat after using it. Discontinuing inhalers leads to worsening of asthma symptoms, which can be harmful to the baby.
Monitoring Asthma During Pregnancy
Dr Maturu said mothers with asthma should have regular checkups not only with their obstetrician but also with their asthma specialist. Asthma control is assessed by the frequency at which the symptoms occur (day-time and night-time), the frequency of asthma attacks (exacerbations), and by performing tests to assess lung function, like peak expiratory flow rate monitoring and spirometry. However, spirometry may give falsely low values during the latter half of pregnancy due to a rise in the intra-abdominal pressure as the foetus grows, so it’s important to have your doctor put it into the right context.
Avoiding Asthma Triggers
In addition to using medicines (inhalers), it is also important for the mother to avoid exposure to triggers which can lead to asthma symptoms. The common triggers for asthma symptoms include exposure to dust (indoor as well as outdoor), strong smells, pollution, cold atmosphere, pollen and pets.
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Treating Asthma Comorbid Conditions
Asthma is usually associated with other medical conditions like allergic rhinitis, gastroesophageal reflux disease (acidity and reflux), anxiety and depression. Poor control of these associated conditions can lead to poor control of asthma. Dr Maturu said, "Because of the physiologic, hormonal, and anatomic changes that happen during pregnancy, there can be worsening of rhinitis, reflux disease as well as depression during pregnancy." Good control of these comorbid diseases is also important to ensure good control of asthma.
Lifestyle Modifications
Following a healthy lifestyle also helps improve asthma symptoms. Doing simple exercises daily, like walking for 30 minutes, have a positive impact on the body. Yoga and breathing exercises are also beneficial. Stress is a trigger for asthma symptoms, and controlling it via meditation can also help. Obesity can lead to worsening asthma symptoms, thus, it is important to avoid excessive weight gain during pregnancy.
Bottomline
Ensuring good management of asthma is paramount for the mother and the healthy child. Avoiding asthma triggers, proper and regular use of medicines, treating comorbid conditions, and following a healthy lifestyle help manage asthma during pregnancy.
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