By Howard LeWine, M.D.
Q: Can I continue to take my asthma medication if I am pregnant?
A: It is important to keep your asthma under control during pregnancy, even if it means taking multiple medications.
Most asthma medicines are thought to be safe to use. It is safer to take your asthma medicines than to have asthma symptoms during pregnancy. Untreated asthma can put you and your baby at risk. If you have bad asthma symptoms, the baby might not get enough oxygen. You could also have a smaller baby or deliver prematurely. Taking your medication can protect you and your baby.
Which medicines are safe during pregnancy? Most doctors think that inhaled asthma medicines are safer than pills because they have fewer side effects. If you use an inhaler, most of the medicine goes directly to your lungs. It is not likely to harm your baby.
Quick-relief medicines known as short acting inhaled beta agonists are considered safe. Albuterol (Ventolin, Proventil) inhalers are the ones doctors prescribe most often. This medicine quickly helps relax tight airways to ease breathing.
The inhaled long-acting beta agonist inhalers such as salmeterol (Serevent) and formoterol (Foradil) appear to be safe as well. However, they should never be used for quick relief, only to help control symptoms and prevent asthma flare-ups.
Anyone with asthma should never use long-acting beta agonist inhalers alone, whether or not the person is pregnant. They must be combined with a corticosteroid inhaler. Inhaled corticosteroids are very effective for long-term control. Studies suggest these are safe to use during pregnancy.
Drug companies have combined long-acting beta agonists and corticosteroids into one inhaler. Brand names include Advair, Dulera and Symbicort.
A different type of long-acting inhaler can also help keep airways open in people with asthma. It’s called ipratropium (Atrovent). It also appears to be safe during pregnancy.
If a bad asthma flare occurs, you may need to take corticosteroid pills such as prednisone. Taken for a short period of time, corticosteroid pills are almost as safe for the baby as inhaled steroids. Not controlling the asthma puts the baby at much more risk.
The medicines mentioned so far also can be used if you breastfeed your baby.
Drugs called leukotriene modifiers can also help control asthma symptoms. If a pregnant woman is not responding to the first line drugs for asthma, two of these medicines are likely safe. They are montelukast (Singulair) and zafirlukast (Accolate). The one that should be avoided during pregnancy is zileuton (Zyflo).
(Howard LeWine, M.D., is an assistant professor of medicine at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)