Asthma Classification and Management in Pregnancy

General Principles

The American Academy of Family Physicians recommends that asthma severity in pregnancy be determined by assessing both impairment and risk domains, just as in non-pregnant patients 1
The American Academy of Family Physicians classifies asthma into four categories: intermittent, persistent-mild, persistent-moderate, and persistent-severe 1
The American Academy of Family Physicians suggests that classification should ideally be determined before initiating therapy to guide appropriate treatment selection 1

The American Academy of Family Physicians defines the impairment domain by daytime symptoms frequency, nighttime awakenings, short-acting beta-agonist use, interference with normal activity, and lung function 1
The American Academy of Family Physicians defines the risk domain by history of exacerbations requiring oral systemic corticosteroids, with final classification determined by the most severe category in which any feature occurs 1

The European Respiratory Society recommends monthly monitoring of asthma symptoms and lung function throughout pregnancy due to the unpredictable course 2
Approximately one-third of women experience improved asthma symptoms, one-third have unchanged symptoms, and one-third have worsened symptoms during pregnancy, according to the European Respiratory Society 2, 3
Asthma symptoms tend to be relatively stable during the first trimester and last month of pregnancy, with increased symptoms more common during the second and third trimesters, as reported by the European Respiratory Society 2
The American Academy of Allergy, Asthma, and Immunology recommends spirometry as the preferred method for objective assessment of lung function in pregnant women with suspected asthma 4

The European Respiratory Society identifies specific phenotypes like allergic or eosinophilic asthma as more likely to worsen during pregnancy 2
The European Respiratory Society notes that rhinitis as an indicator of atopy is associated with worsening asthma during pregnancy 2
Overweight or obese pregnant women experience asthma exacerbations twice as frequently as healthy-weight pregnant women, according to the European Respiratory Society 2

Uncontrolled asthma during pregnancy increases risks of pre-term birth, low birthweight, small for gestational age infants, pre-eclampsia, gestational diabetes, and perinatal mortality, as reported by the European Respiratory Society 2
Active asthma management during pregnancy reduces these risks, according to the European Respiratory Society 2
The American Academy of Allergy, Asthma, and Immunology recommends maintaining asthma control as critical for both maternal and fetal well-being, ensuring adequate oxygen supply to the fetus 6
The American Academy of Allergy, Asthma, and Immunology suggests step-wise management based on classification, with short-acting bronchodilators and inhaled corticosteroids as preferred treatments for intermittent and mild persistent asthma, respectively 4, 7