Asthma & Pregnancy: Medications

Reviewed by Kanao Otsu, MD, MPH
We would like to avoid all medicine during pregnancy. A pregnancy without medicine is not always possible or desirable. By working closely with your doctor, you will be able to take the least 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.
 
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 The PLLR also requires the label to be updated when information becomes outdated.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 its use. Remember, uncontrolled asthma can threaten your well-being and that of your baby. Your doctors and you 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.

The following list reviews medicines that are commonly used during pregnancy:
 

Long-Term Control Medicines

Long-term control medicines are used daily to maintain control of asthma and prevent asthma symptoms. These medicines are taken to prevent asthma symptoms even when asthma is stable. They do not provide immediate relief of symptoms.
 

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 inhaled steroids (metered-dose inhaler) and rinsing your mouth after inhaling the medicine reduce the risk of thrush.

  • Pulmicort® (budesonide); Arnuity Elipta® (fluticasone furoate); Flovent® (fluticasone propionate): Budesonide and fluticasone are the most studied of the inhaled steroids. When used as prescribed by a doctor, these medications are safe for the pregnant mother and the baby.

  • Qvar® (beclomethasone); Asmanex® (mometasone); Aerospan® (flunisolide): Several safety studies have shown that when used as prescribed by a doctor, inhaled steroids are safe for the pregnant mother and the baby.

 

Leukotriene Modifiers

Common Leukotriene Modifiers include:
Singulair® (montelukast); Accolate® (zafirlukast)

Singulair and Accolate are also long-term control medicines. There have been fewer years of experience with these medicines than with other asthma 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 leukotriene modifiers 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 doctor, 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 use more than one of these metered-dose inhalers in a month, talk with your doctor. 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:

  • Deltasone® (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 dose.

 

Clinical Trials

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