Asthma is one of the most common diseases that complicate pregnancy and a risk factor for several maternal and fetal complications including increased perinatal mortality. Management of asthma during pregnancy poses a special challenge for physicians, as asthma influences the outcome of pregnancy and - vice versa - pregnancy affects asthma severity with bidirectional immunological interactions. Attenuation of allergic responses can be detected in controlled asthmatic pregnant patients supporting the presence of pregnancy-induced immune tolerance. However, uncontrolled asthmatic pregnant women show significant asthma-associated immune reactions, such as diminished pregnancy specific regulatory T cell proliferation and elevation of Thelper-17 cell numbers, which may - besides other factors - influence fetal growth. Uncontrolled, symptomatic asthma increases the risk of adverse perinatal outcomes; thus adequate regular anti-asthmatic treatment resulting in optimal asthma control represents a vital need during pregnancy. The diagnosis of asthma is usually known before pregnancy, but if symptoms occur for the first time during gestation, reduced forced expiratory volume in one second (FEV1) and a 12% or greater improvement in FEV1 after inhalation of a rapid acting beta-agonist confirm the diagnosis of asthma. Testing bronchial hyperresponiveness is contraindicated during pregnancy. Therapy of asthma during pregnancy must aim to control the disease, including mitigating asthma triggers as much as possible. Asthmatic women with controlled asthma should continue taking their medications during pregnancy and maintenance therapy should be increased by one step in patients with asthma that is not controlled. Very poorly controlled asthma during pregnancy is treated similarly to that in nonpregnant patients. This chapter summarizes immunological changes characterizing pregnancy in asthmatic women together with the clinical implications of asthma management during pregnancy.
|Title of host publication||Pregnancy|
|Subtitle of host publication||Risk Factors, Management and Recovery|
|Publisher||Nova Science Publishers, Inc.|
|Number of pages||18|
|Publication status||Published - Feb 1 2012|
ASJC Scopus subject areas