Asthma and Pregnancy: Q and A with Dr. Laura Fisher

Pregnancy is the most wonderful time for most women.  It is a time of great expectations and always, some concerns for the new life that a woman is responsible for.  A mother-to-be doesn’t know what to expect from day to day.  She can be tired and cranky one day and happy the next. The last thing she needs is an asthma attack.

Asthma affects approximately 4-12% of pregnancies. It’s the most common chronic condition. It affects both the mother and the fetus she carries. This is because the shortness of breath associated with asthma onset during pregnancy leaves less oxygen for both of them. However, if the asthma is managed properly with medication and precautions, women can have a fairly normal pregnancy.

Dr. Laura Fisher is married and has one young child.  Her outside interests include hiking, skiing, horseback riding and gardening.  On their farm, she and her husband have nine sheep, one cat, one rooster and four “Easter Egg” chickens that lay blue eggs.  Here she talks about the concerns that an asthmatic mother-to-be faces. 

Q:  Dr. Fisher, let’s begin with what happens during an asthma attack.

Dr. Fisher:  During an asthma attack you can feel a variety of symptoms.  You can be short of breath. You can have coughing. You can have chest tightness and wheezing. There are usually different phases to an asthma attack. You can develop mucus in your lungs and you also have narrowing of the airways.  It is the combination of the mucus and the narrowing of the airways that makes it difficult to breathe. Asthma is a chronic disease and if it is not treated correctly on a long-term basis you can develop thickening of the airways leading to more permanent damage.

Q:  Why is this a special concern for the asthmatic mother-to-be?

Dr. Fisher:  Women with asthma, about one-third of the time, get worse with their pregnancies and it is especially important because babies need oxygen more than anything else. One of the things we try to do with our asthmatic mothers is to manage them optimally before they are pregnant and then during their pregnancy we try to keep them out of trouble. This includes optimizing medications for the individual patient during pregnancy.

Q:  Does pregnancy affect asthma or does asthma affect pregnancy?

Dr. Fisher:  Both can be true. The hormonal changes in pregnancy can worsen asthma in about one third of cases.  Poorly controlled asthma can mean adverse outcomes for mother and baby. You can have preterm delivery of the fetus. You can have a small birth weight baby that can lead to other health issues. You can have pre-eclampsia, a high blood pressure disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby. All of these put the fetus and the mother at risk in addition to the asthma attack itself.

Q:  Can a doctor predict how asthma will affect a particular pregnancy?

Dr. Fisher:  Usually not. Sometimes past pregnancies are a clue but not always.  If you had trouble with one of your other pregnancies it is especially important that you be monitored carefully but that is not always a good predictor. I consider it so important that I usually do a breathing test on my pregnant asthmatics at least once during the first trimester and monitor them closely throughout the pregnancy, often on a monthly basis.

Q:  Going back to the woman who does have asthma and is pregnant, do changes need to be made to the medications she has been taking for asthma before pregnancy?

Dr. Fisher:  The important thing about asthma, pregnancy and medications is not to stop medicines without consulting your doctor. Everyone is always afraid when they are pregnant and they want to stop their medicines. They do not want to take anything.  I remember when I was pregnant someone gave me a cough drop and I quickly spit it out because I was concerned about what was in it. Well, I know that’s ridiculous but that can be the mindset when you’re pregnant. You don’t want to do anything to harm your baby.  But, especially with asthma, you are harming your baby if you are not taking your medications, and especially if your asthma is poorly controlled.

Q:  It sounds kind of complex.  Is it really important for a pregnant asthmatic woman to see an allergist?

Dr. Fisher:  I recommend it in general.  I feel it is mandatory for those with moderate or severe asthma, frequent daytime or nighttime symptoms, oral steroid use for asthma in the past year, or ER visits for asthma. I would recommend that a pregnant woman make an appointment with her doctor and go through all the medications she is on and then make substitutions as appropriate.  Ideally, if a woman thinks she is going to become pregnant she should set up an appointment with her doctor, allergist or pulmonologist ahead of time so adjustments can be made. If she waits until she finds out she is pregnant she has already been pregnant through the early formative stage of the fetus for a while.

Q: Do you recommend that she stay away from certain medications?

Dr. Fisher: I usually recommend staying away from decongestants. Those are things like Sudafed or pseudoephedrine products. If she has nasal congestion, salt water rinses are fine to use. Prescription medications are a subject we will discuss together.

Q:  Are women with asthma that is uncontrolled more likely to have complications during pregnancy and, if so, what would they be?

Dr. Fisher:  Absolutely. I’ve already mentioned pre-eclampsia. Others include preterm labor which puts not only the fetus but the mother at risk as well. If their asthma is poorly managed and triggered by the pregnancy, pregnant women are at risk for airway compromise and breathing difficulties.

Q: Do women generally face a higher risk for bad outcomes from asthma?

Dr. Fisher: Yes, in fact they are at a higher risk for mortality from asthma.  Women have more frequent emergency room visits for asthma.  If they are admitted to the hospital for asthma, their stay is likely to be longer and often they will end up needing more albuterol medication than men will for their asthma.

Q:  Do the babies tend to have lower birth weight?

Dr. Fisher:  Yes, if they are poorly controlled asthmatics.  If they are well controlled asthmatics that should not be as much of an issue.

Q:  Do allergists and obstetricians usually work together to treat the mother-to-be?

Dr. Fisher:  I have been very pleased with my interactions with the obstetricians in this area.  We usually send letters to each other or make a phone call if someone is feeling sick or really ill.

Q: What should an asthmatic pregnant woman do if she has a severe asthma attack?

Dr Fisher:  That’s when she needs to call 911 or go to the emergency department, and tell them right away that she is pregnant and has a history of asthma. Her doctors will provide excellent guidance here.  I suggest the use of an inhaler like albuterol as a rescue inhaler if she has it and then seek emergency attention.

Q:  How soon can you tell whether a baby or child is apt to have asthma?

Dr. Fisher:  A lot of children will wheeze with viral infections.  That does not mean they are going to have asthma.  Sometimes you will hear the term  ”reactive airway disease” and the treatment will be very similar to asthma. Asthma is more of a clinical diagnosis based on symptoms, and diagnosis will be made with careful follow-up with your pediatrician.

Q: What is one of the most common triggers for asthma?

Dr. Fisher: Exercise-induced asthma affects the majority of all patients with asthma. Many people can be out of shape or having anxiety but if you are having shortness of breath, wheezing or severe coughing during exercise, and especially if it is limiting your function, then it is something you should be talking over with your doctor. One in six of the athletes at the 2008 summer Olympic Games in Beijing had asthma, so it can obviously be managed very well.

Q:  Anything else you would like to add?

Dr. Fisher:  I would just like to also emphasize environmental problems that can affect your asthma, such as smoking, pollens, molds, house dust and animals. It is so important to seek prenatal care as soon as you find out you’re pregnant so that risk factors can be managed.  And, if you are planning on becoming pregnant soon, talk that over with your family doctor or your allergist ahead of time. Managing and treating asthma during pregnancy can prevent hospitalization, emergency room visits, work loss and chronic disability. If it is controlled, you have just as much chance of a healthy, normal pregnancy as a woman who does not have asthma.

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