General strategy for the management of bronchial asthma in pregnancy.
Epidemiological studies showed that bronchial asthma is one of the most common diseases which can complicate pregnancy (1-7%). In about 0.05-2% of the cases, asthma occurs as a life-threatening event. In the common medical practice a waiting strategy or, even, the complete refusal for drug therapies are frequently observed. This is justified by the fear of the possible adverse effects of drugs on developing fetus. On the contrary, several studies have demonstrated that severe and uncontrolled asthma may produce serious maternal and fetal complications, such as gestational hypertension and eclampsia, fetal hypoxemia and an increased risk of perinatal death. Therefore, all pregnant women suffering from bronchial asthma should be considered as potentially at high risk of complications and adequately treated. Since asthma is a chronic disease with acute exacerbations, a continuous treatment is mandatory to control symptoms, to prevent acute episodes and to reduce the degree of airway inflammation. The global strategy for asthma management in pregnancy includes five main topics: (1) objective evaluation of maternal/ fetal clinical conditions; (2) avoidance/control of triggering factors; (3) pharmacological treatment; (4) educational support; (5) psychological support. As far as drug therapy is concerned, the International Guidelines and Recommendations suggest that the general strategy does not differ significantly from management outside pregnancy. We herein review and discuss the available data and the criteria for the management of asthma in pregnant patients.
Liccardi
G
G
Unit of Pneumology and Allergology, Department of Chest Diseases, A.Cardarelli Hospital, Piazza Arenella no 7/h, Naples 80128, Italy. gennaro.liccardi@tin.it
Cazzola
M
M
Canonica
G W
GW
D'Amato
M
M
D'Amato
G
G
Passalacqua
G
G
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000328:Adult; D000730:Androstadienes; D000772:Anesthesia, Local; D000773:Anesthesia, Obstetrical; D001249:Asthma / Q000188:drug therapy* / Q000523:psychology / Q000628:therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D000075202:Contraindications; D004205:Cromolyn Sodium / Q000627:therapeutic use; D005260:Female; D000068298:Fluticasone; D005938:Glucocorticoids / Q000627:therapeutic use; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D007167:Immunotherapy; D007744:Obstetric Labor Complications / Q000188:drug therapy; D010120:Oxytocics; D010353:Patient Education as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000523:psychology / Q000628:therapy; D013806:Theophylline / Q000009:adverse effects / Q000627:therapeutic use
D000318:Adrenergic beta-Agonists; D000730:Androstadienes; D001993:Bronchodilator Agents; D005938:Glucocorticoids; D006634:Histamine H1 Antagonists; D010120:Oxytocics; D013806:Theophylline; D000068298:Fluticasone; D004205:Cromolyn Sodium