title: Management of asthma during pregnancy.
abstract: Asthma is an inflammatory lung condition that is the most common chronic disease affecting pregnancy. The changes in pulmonary physiology during pregnancy include increased minute ventilation, decreased functional residual capacity, increased mucus production, and airway mucosa hyperemia and edema. Pregnancy is also associated with a physiological suppression of the immune system. Many studies have described the heterogeneous immune system response in women with asthma during pregnancy, which partly explains why asthma has been shown to worsen, improve, or remain stable in equal proportions of women during pregnancy. Asthma may be associated with poor maternal and fetal outcomes. However, better maternal and fetal outcomes are observed with better asthma control. Asthma controller medications are generally thought to be safe during pregnancy, but limited data are available for some of the medicines. Newer medications like omalizumab open avenues for the treatment of asthma, but also pose a challenge, as there is limited experience with their use. Therefore, a multidisciplinary approach, including obstetricians, asthma specialists, and pediatricians should collaborate with the patient to carefully weigh the risks and benefits to determine an optimal management plan for each individual patient. The aim of this review article is to summarize the most recent literature about the immunological changes that occur during pregnancy, physiological and clinical implications of asthma on pregnancy, and asthma management and medication use in pregnant women.
authors.affiliation: Division of Pulmonary Diseases and Critical Care, University of Texas Health Science Center at San Antonio, 7400 Merton Minter MC 111E, San Antonio, TX 78229, USA. masellicacer@uthscsa.edu
authors.forename: Diego J
authors.initials: DJ
authors.lastname: Maselli
authors.forename: Sandra G
authors.initials: SG
authors.lastname: Adams
authors.forename: Jay I
authors.initials: JI
authors.lastname: Peters
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Levine
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000420:Albuterol / Q000008:administration & dosage; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000888:Antibodies, Anti-Idiotypic / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001249:Asthma / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage; D018450:Disease Progression; D005260:Female; D006801:Humans; D000069444:Omalizumab; D021041:Placental Circulation / Q000502:physiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000628:therapy*; D011256:Pregnancy Outcome; D012121:Respiration, Artificial; D012129:Respiratory Function Tests
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D000888:Antibodies, Anti-Idiotypic; D061067:Antibodies, Monoclonal, Humanized; D001993:Bronchodilator Agents; D000069444:Omalizumab; D000420:Albuterol