Medicine Therapy to Control Asthma During Your Pregnancy

We would like to avoid all medicine during pregnancy. However, a pregnancy without medicine is not always possible or desirable. It is safer for pregnant women with asthma to be treated with asthma medications than for them to have asthma symptoms and exacerbations. Maintaining adequate control or asthma during pregnancy is important for the health and well-being of both the mother and her baby.*

By working closely with your doctor, you will be able to take the least medicine necessary for good asthma control. It is important that your asthma be controlled to assure your baby's oxygen supply and decrease your health risk.

The U.S. FDA has classified medicine into categories based on safety for the mother and baby. Medicine is rated A, B, C, D and X.  A is the safest and X is not safe - X is absolutely contraindicated . All medicines approved since 1980 are classified in one of these categories. No medicines used to treat asthma fall into category A (adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities). Some fall in category B (animal studies have revealed no evidence of harm to the fetus, however, there are no adequate and well-controlled studies in pregnant women).

Most of the medicine used to treat asthma fall into category C (animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women; or, no animal studies have been conducted and there are not adequate and well-controlled studies in pregnant women). Category C asthma drugs are generally considered safe for both mother and child. 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. You and your doctors share a common goal throughout your pregnancy. This goal is to keep you healthy, happy, 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 seemingly harmless things can be harmful to your baby. Ask your healthcare provider about any medicine before you take it. Take only medicine your healthcare provider has approved or prescribed.

The following list reviews medicine that is commonly used during pregnancy:

Long-Term Control Medicines
Quick-Relief Medicines
Inhaled Medicine Technique
Other Asthma Related Medication Treatment

Long-Term Control Medicines

Long-term control medicines are used daily to maintain control of asthma and 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)
• Vanceril®, Beclovent®, Qvar® (beclomethasone)
• Flovent (fluticasone)

Inhaled Pulmicort® (budesonide) is the only inhaled steroid to be included in category B, based on existing evidence. All other inhaled steroids are category C. 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 cause few, if any, side effects in usual 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 reduces the risk of thrush. 

Learn more about inhaled steroids.

Cromolyn Sodium and Nedocromil

Intal® (cromolyn) and Tilade® (nedocromil) are also long-term control medicines, available in inhaled forms. They are category B. They help to prevent asthma symptoms, especially symptoms caused by exercise, cold air and allergies. When used routinely, each helps prevent swelling in the airways. They are often taken on a regular basis, but may also be used as a pre-treatment before exposure to things that make asthma worse. They are much less effective than inhaled steroids and leukotriene modifiers.

Learn more about cromolyn sodium and nedocromil.

Leukotriene Modifiers

Singulair® and Accolate® are also category B long-term control medicine. 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 as effectively as inhaled steroids.

There have been fewer years of experience with this class of drugs than with other asthma medicine. For this reason, and because minimal data are currently available on the use of these drugs during pregnancy, they should be avoided.

Learn more about leukotriene modifiers.

Theophylline

Common theophyllines include:

• Slo-Bid®
• Uniphyl®
• T-phyl®

Theophylline, a long-term control medicine, relaxes the smooth muscles around the airways. Theophyllines are in category C. Studies and clinical experience confirm the safety of this drug at recommended doses that result in a serum theophylline level of 5-15 mcg/ml. But because of side effects (usually at higher serum levels) theophylline is not one of the first medicines used for long-term control of asthma. There are safer and more effective medicines available.

Learn more about theophylline.

Learn more about long-term control asthma medications that relate to anyone with asthma, not just asthma during pregnancy.

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Quick-Relief Medicines

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

Short-Acting Beta-Agonists

Common inhaled beta-agonists include:

• Proventil®, Proventil HFA®, Ventolin® (albuterol)
• Xopenex® (levalbuterol)
• Maxair® (pirbuterol)
• Combivent® (albuterol and ipratropium)

These medicines are category C but have been used for decades and are deemed to be safe for both mother and fetus. Short-acting beta-agonists provide quick relief by relaxing 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 consistently under good control since you are "breathing for two."

Learn more about short-acting beta-agonists.

Oral steroids

Common steroid pills and liquids include:

• Deltasone® (prednisone)
• Medrol® (methylprednisolon)

A short term burst of oral steroids may be needed to decrease the severity of asthma symptoms and prevent an emergency room visit, but should be discontinued as soon as asthma control is achieved. Oral steroids are very effective at reducing swelling and mucus production in the airways. They also help other quick relief medicine work better. 

Sustained use of oral steroids has been associated with pre-eclampsia, an undesirable condition associated only with pregnancy.

Learn more about oral steroids.

Learn more about quick-relief asthma medications that relate to anyone with asthma, not just asthma during pregnancy .

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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 you should use a spacer.

This is especially important with inhaled corticosteroids. Ask your healthcare provider to watch your techniques with the inhaled medicine to make sure you are using it correctly.

Read additional information about devices used with inhaled asthma medications that relates to anyone with asthma, not just asthma during pregnancy.

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Other Asthma Related Medication Treatment

• Annual influenza vaccine (flu shot) - The annual flu shot is recommended for pregnant women with asthma during the second or third trimester. Read more about the flu vaccine here.
• 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. Read more about allergy shots here.

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*National Asthma Education & Prevention Program - U.S. Department of Health & Human Services (HHS) - Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment - Update 2004.

This information has been approved by Phil Corsello, MD (March 2006).