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Asthma & Pregnancy: Medications

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This information was reviewed and approved by Flavia Cecilia Lega Hoyte, MD (2/6/2023).

By working closely with your healthcare provider, you will be able to take the least amount of medicine necessary for good asthma control.

It is most important that your asthma be controlled to assure your baby’s oxygen supply and decrease your health risk.
It is most important that your asthma be controlled to assure your baby’s oxygen supply and decrease risks to your health and to your baby.
All prescription medications approved by the FDA after June 2001 are labeled according to the Pregnancy and Lactation Labeling Rule (PLLR). The PLLR also requires the label to be updated when information becomes outdated. Older medications, approved by the FDA before June 2001, as well over-the-counter medications, may still follow the old pregnancy letter categories — A, B, C, D and X.

As with any medicine used during pregnancy, you and your doctor need to weigh the benefits versus the risks of your asthma medications. Remember, uncontrolled asthma can threaten your well-being and that of your baby. You and your doctors share a common goal throughout your pregnancy. The goal is to keep you healthy and breathing normally. This often requires the use of medicine to control asthma.

Review all the medicine you are taking with your doctor. This includes over-the-counter medicine, vitamins and any herbal supplement you may be taking. Even these could be harmful to your baby. Ask your health care provider about any medicine before you take it. Take only medicine your health care provider has approved or prescribed.

Long-Term Control Medicines

Long-term control medications are used once or twice daily to maintain control of asthma and prevent asthma symptoms. These medicines are taken to prevent asthma symptoms even when asthma is stable. Very few of these medications provide immediate relief of symptoms and should only be used for this purpose if instructed by your healthcare provider.

Inhaled Steroids

Common inhaled steroids used during pregnancy include:
Pulmicort® (budesonide); Arnuity Elipta®(fluticasone furoate);
Flovent® (fluticasone propionate); Qvar® (beclomethasone);
Asmanex® (mometasone); and Aerospan® (flunisolide).

Inhaled steroids prevent and reduce swelling in the airways and may decrease mucus production. Inhaled steroids are the most effective long-term control medicine now available. They improve asthma symptoms and lung function. They have also been shown to decrease the need for oral steroids and hospitalization. Inhaled steroids are taken on a regular basis and are safe to use while pregnant at commonly prescribed doses. Thrush, a possible side effect, is a yeast infection causing a white discoloration of the tongue. Using a spacer with those inhaled steroids delivered by metered-dose inhaler and rinsing your mouth after inhaling any inhaled steroid will reduce the risk of thrush.

Budesonide is the inhaled steroid that has been most studied during pregnancy, but all inhaled steroids are thought to be safe for the pregnant mother and the baby when used as prescribed by a healthcare provider.

Leukotriene Modifiers

Common leukotriene modifiers include:
Singulair® (montelukast); Accolate® (zafirlukast); Zyflo (zileuton)

Montelukast, zafirlukast and zileuton are also long-term control medicines. They reduce swelling inside the airways and relax smooth muscles around the airways. They are available as tablets. They are effective at improving asthma symptoms and lung function, but not to the same extent as inhaled steroids. Safety studies have shown use of montelukast and zafirlukast while pregnant does not increase health risk for the pregnant mother or the baby.


Quick-Relief Medicines

Quick-relief medicines are used to treat asthma symptoms or an asthma episode.

Short-Acting Beta-Agonists

Common inhaled beta-agonists include:

  • Proventil®, Ventolin®, ProAir® (albuterol)
  • Xopenex® (levalbuterol)
  • Combivent® (albuterol and ipatropium)

Available studies have shown that short-acting beta-agonists, when used as prescribed by a healthcare provider, are safe for the pregnant mother and the baby. They are quick-relief medicines. These medications have been used by pregnant mothers for decades and are deemed to be safe. Short-acting beta-agonists work quickly to relieve asthma symptoms. Beta-agonists relax the smooth muscles around the airways. If you are needing more than your usual amount of these relief medications, discuss this with your healthcare provider. This is a sign that your asthma is poorly controlled, and your long-term control medicine may need to be adjusted. Remember, your asthma needs to be under good control, since you are “breathing for two.”


Oral Steroids

Common steroid pills and liquids include:

  • Prednisone
  • Medrol® (methylprednisolone)

Your health care provider may have you take a short-term burst of oral steroids if you have severe asthma symptoms. The burst may also prevent an emergency room visit. The steroid burst should be discontinued as soon as possible. Oral steroids are very effective at reducing swelling and mucus production in the airways. They also help other quick-relief medicine work better. Intravenous (IV) steroids also may be given to control severe episodes.

Inhaled Medicine Technique

It is crucial that you use your inhaled medicine correctly to get the full dosage and benefits from the medicine. If you are using a metered-dose inhaler, a spacer device is often recommended. This is very important with inhaled steroids. Ask your health care provider to watch your technique with the inhaled medicine to make sure you are using it correctly. Read about the top 10 inhaler mistakes.


Other Asthma Related Medication Treatment

Annual influenza vaccine (flu shot)

The annual flu shot is recommended for pregnant women with asthma. It is given during the second or third trimester.


Immunotherapy (allergy shots)

Allergy shots should not be started during pregnancy. However, if you have been receiving allergy shots and have not shown any severe reactions, you may continue them at the same constant dose for the duration of pregnancy without increasing the dose until after delivery.

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