Asthma Management During Labor

Introduction to Asthma Management

The American College of Obstetricians and Gynecologists recommends continuing all current asthma medications during labor and delivery, as the risk of uncontrolled asthma to the mother and fetus is much greater than any risk from the medication 1

The American Thoracic Society suggests that all asthma medications, including inhaled corticosteroids and long-acting controllers, should be continued during labor and delivery to prevent uncontrolled asthma, which can increase the risk of preeclampsia, preterm birth, low birth weight, and perinatal mortality 1
The use of epidural anesthesia with local anesthetics is preferred for pain relief during labor, as it reduces maternal anxiety and stress, and avoids respiratory depression 1

The National Asthma Education and Prevention Program recommends that if asthma symptoms occur during labor, the first step is to assess and oxygenate the mother, maintaining an oxygen saturation >95%, and providing supplemental oxygen if necessary 1
The American Academy of Allergy, Asthma, and Immunology suggests that albuterol (salbutamol) is the preferred medication for acute asthma symptoms during labor, with a dose of 2.5-5mg via nebulizer every 20 minutes for up to 3 doses 2, 1
The addition of ipratropium bromide may be considered, with a combination of 0.5mg ipratropium and 2.5mg albuterol every 20 minutes for 3 doses, and then every 2-4 hours as needed 1

The American College of Obstetricians and Gynecologists recommends that for severe asthma exacerbations during labor, systemic corticosteroids such as prednisolone 60mg/day or methylprednisolone 1-2mg/kg/day (maximum 60mg/day) may be used for 3-10 days 3
The benefits of corticosteroids outweigh the risks in acute asthma exacerbations 2, 1

The American Academy of Pediatrics recommends that women with asthma should be closely monitored for 24-48 hours after delivery, as this is a high-risk period for cardiopulmonary complications 1
All asthma medications should be continued postpartum, and breastfeeding is encouraged, as all asthma medications, including albuterol, budesonide, and prednisone, are compatible with breastfeeding 1