Asthma is a prevalent condition in Australia with 2.8 million people (10.8%) as of 2022 living with the condition. Women are at a higher risk than males and pregnancy can add to the difficulty of symptom management. Although much research is still required as to the “why”, immunological changes through T-helper 2 immune environment or mechanical changes such as uterus growth are potential influencers.
Statistics:
- 40% of women with asthma have worse symptoms during pregnancy.
- 3-fold increase for occurrence of exacerbations in moderate – severe asthma over mild.
- Increased risk of respiratory virus infection.
- Infants of an asthma population have a 1.27, 1.25 and 1.36 increased chance of requiring NICU, having respiratory distress syndrome and congenital malformations respectively.
Risk Population:
- Current or ex-smoker
- Non-Caucasian ethnicity
- Diagnosis during adulthood
- Lower maternal age
- Starting ICS later in pregnancy
Hurdles to overcome:
- Percetions on inhaler use:
- Unpleasant taste and throat or mouth symptoms.
- 1/5 women believe it could be harmful to their baby.
- Usual dose of SABA and ICS have not been associated with increased risk of malformations, pre-term delivery or low birth weight and can be taken in conjunction.
- Other conditions such as rhinitis, reflux and depression/ anxiety.
- Behavioural traits including smoking, Inhaler technique, Diet and Reduced physical activity.
How a General Practitioner can help?
- Ask about changes in your patient’s asthma with each regular visit. This is necessary as midwives and obstetricians potentially lack knowledge and confidence with specific asthma advice.
- Encourage spacer use and check technique (<50% adequate use).
- Increase education towards continuing inhaler use.
- Asthma plan (85% of pregnant women do NOT have one).
- Perform lung function testing as required – Remain safe and accurate, changes to FVC and FEV1 are due to asthma changes, not pregnancy.
- Breastfeed as usual.
Challenges postpartum:
- Change in mother’s symptoms for 1 year (hypothesised to be hormonal).
- Symptoms become worse for more than 50% of asthmatics within 3 months.
- ICS non-adherence increased, being at its worse during the 6 month stage.
- Asthmatics are less inclined to begin breast feeding and continue this beyond 6 months.
References:
- https://www.abs.gov.au/statistics/health/health-conditions-and-risks/asthma/latest-release
- Murphy, V. E., & Jensen, M. E. (2024, April). Managing asthma in pregnancy. Respiratory Medicine Today, pp. 11-15.
- https://asthmapregnancytoolkit.org.au/medications/inhaled-corticosteroids-ics/
