Asthma in Special Situations
1) Asthma in elderly
2) Asthma in Pregnancy
Asthmatic bronchitis complicates on and average 4 to 8 % of pregnancies.
Poorly managed or uncontrolled asthma during pregnancy can adversely affect the mother and infants health.
Maternal asthma increases the risk of pre-eclampsia, preterm birth and low birth weight
Perinatal mortality was significantly increased among females with asthma compared to females without asthma
Pregnancy worsens asthma control in one‐third of women, improves it in one‐third and has no effect on one‐third.
Why is it important for you to keep your asthma under control during pregnancy?
Asthma attacks during pregnancy increases the risk of low birth weight babies. In addition, oral corticosteroids used in the treatment of severe asthma attack might increase the risk of preterm delivery. So that it becomes utmost important for you to keep your asthma under control by taking your medication regularly.
What is the role of asthma severity on the pregnancy outcome?
Females with moderate or severe asthma were more likely to have small for gestational age or low birth weight babies than females with mild asthma.
Scientific evidence has emerged to suggest that optimal asthma control during pregnancy improves perinatal outcomes.
Do I need to change my asthma plan during pregnancy?
Management guidelines for pregnant females with asthma are generally the same as for non-pregnant females with asthma. However, many females reduce or discontinue their asthma medication during pregnancy. That becomes a common trigger for the asthma exacerbation in pregnant women.
Viral respiratory infections and asthma in pregnancy
Viral infections are the most common triggers of asthma exacerbations in adults and children as well as during pregnancy. Respiratory viral infection was a common self-reported trigger of asthma exacerbations requiring medical intervention
In conclusion, pregnant females with asthma are particularly susceptible to viral upper respiratory tract infections, which frequently lead to loss of asthma control or exacerbations. Prevention of these infections would probably improve asthma control and reduce exacerbations of asthma during pregnancy. Improved asthma control during pregnancy may, in turn, reduce the likelihood of viral upper respiratory tract infections
Common asthma medications and safety data As per the WHO website
| Drug | Safety Data |
| Inhaled bronchodilators (e.g. Albuterol, Formoterol and Salmeterol) | Human data generally reassuring for short acting and long-acting bronchodilators |
| Theophylline | Reassuring human data; serum levels must be monitored to avoid toxicity |
| Systemic corticosteroids | Human data from smaller case control studies show increase in oral clefts. Larger prospective studies show increase in low birth weight, preterm birth, preeclampsia and intrauterine growth retardation. |
| Inhaled corticosteroids | Human data mainly reassuring. There may be an increased risk of malformations seen with higher doses. |
| Leukotriene Receptor Antagonist (e.g. Montelukast, Zafirlukast) | Human data are generally reassuring |
| 5-Lipoxygenase-Inhibitor | Generally avoided during pregnancy due to the available less reassuring animal data. |
| Omalizumab | Increased risk of low birth weight and preterm birth; likely severity of asthma may confound to these observations. |
Common allergic rhinitis medications and safety data
| Oral antihistamines (e.g. Azelastine, Cetirizine, Chlorpheniramine, Dexchlorpheniramine, Fexofenadine, Diphenhydramine, Hydroxyzine, Loratadine) | Human data are generally reassuring. Hydroxyzine should be used cautiously during first trimester based on animal data. Fexofenadine (an active metabolite of Terfenedine): no reports of increased congenital malformations, however, no epidemiologic studies in human pregnancy available. |
| Oral and Nasal Decongestants (e.g. Oxymetazoline, Phenylephrine, Phenylpropanolamine, Pseudoephedrine) | Oxymetazoline has been associated with possible uteroplacental insufficiency at higher doses. Phenylephrine has been associated with clubfoot and eye/ear malformations. Phenylpropanolamine associated with congenital malformations, gastroschisis and ventricular septal defect. Pseudoephedrine associated with gastroschisis, hemifacial microsomia and small intestinal atresia in some case-control studies. |
| Intranasal Antihistamines (e.g. Azelastine, Olapatadine) | Animal studies are reassuring. |
| Intranasal Corticosteroids (e.g. Budesonide, Fluticasone, Triamcinolone, Mometasone) | Substantial reassuring data for inhaled corticosteroids. Risk of increased malformations at high dose, but severity of allergic rhinitis may be a confounding factor for these outcomes. |
