Oral Corticosteroids for Asthma Exacerbations During Pregnancy

Benefits of Treating Asthma Exacerbations During Pregnancy

• Uncontrolled asthma increases the risk of perinatal mortality, pre-eclampsia, preterm birth, and low birth weight infants 1, 3
• Maintaining lung function is essential to ensure adequate oxygen supply to the fetus 1

Management Approach for Asthma Exacerbations in Pregnancy

First-Line Treatment

• The American College of Allergy, Asthma, and Immunology recommends short-acting beta-agonists (preferably albuterol) as first-line treatment: 2-4 puffs every 20 minutes for up to 3 doses or a single nebulizer treatment as needed 2, 4
• Albuterol is the preferred SABA because more safety data are available during pregnancy 1, 2

When to Add Oral Corticosteroids

• A course of systemic corticosteroids is indicated when exacerbations are not quickly controlled with bronchodilators 2, 5
• Oral corticosteroids should be used when asthma symptoms are not controlled with other medications or during severe exacerbations 3

Dosing of Oral Corticosteroids

• For outpatient management: Prednisone 40-60 mg daily for 3-10 days 4
• For more severe exacerbations: Prednisone 120-180 mg/day in 3-4 divided doses for 48 hours, then 60-80 mg/day until peak expiratory flow reaches 70% of predicted or personal best 4

Monitoring During and After Treatment

• After an exacerbation, step down to the least medication necessary to maintain control 2
• Regular monitoring of asthma symptoms and lung function is recommended throughout pregnancy 1, 3
• Monthly evaluations allow for therapy adjustments as needed, as asthma improves in 1/3 of women and worsens for 1/3 during pregnancy 1

Common Pitfalls to Avoid

• Discontinuing asthma medications during pregnancy due to unfounded safety concerns, which can lead to poor asthma control 3, 6

Long-term Management After Exacerbation

• After controlling the exacerbation, review medication technique, adherence, and environmental triggers 2
• Consider stepping up long-term controller therapy if exacerbations are frequent 1
• Inhaled corticosteroids are the preferred long-term control medication during pregnancy, with budesonide having the most safety data 2, 6