Asthma and Pregnancy

You’ve just found out you’re pregnant - congratulations! But you have asthma – how is this going to affect your pregnancy?

It is actually hard to predict how pregnancy will affect your asthma because it is different for every woman.

The most important thing is to remember that the commonly used asthma medications are SAFE in pregnancy. It is important to remember that risks of complications because of your asthma is very small to both you and your baby.

You’ve just found out you’re pregnant - what next?
Make sure you make an appointment to see your doctor and review your asthma treatment. Ensuring you have good asthma control during pregnancy is important to ensure safe delivery of a healthy baby.

Controlling your asthma during pregnancy

  • Good asthma control can be achieved by ensuring that you take your asthma inhalers and medications as prescribed.
  • Have regular check-ups with your doctor every 4-6 weeks during your pregnancy.
  • Inform your obstetrician that you have asthma.
  • If you have persisting symptoms you may need to see an asthma specialist who will then care for you during your pregnancy.
  • Ensure that you have an asthma action plan so you have a clear management plan for your asthma during pregnancy

Don’t smoke
Smoking is not good for your asthma, for your baby and for your health in general. Smoking increases the risk of miscarriage and premature labour – if your baby is born early, there may be a chance that their lungs would not have developed fully leading to risk of wheeze and other lung problems later in life.

Eat Well
There are no restrictions or “pantangs” to what you can eat. The best advice is to have a healthy balanced diet.

Asthma medications are safe in pregnancy.  There is a greater risk to both you and your baby if you don’t take your asthma treatment and your asthma gets worse. These include all inhalers – reliever and preventer, and steroid tablets.

The leukotriene receptor antagonists (montelukast or Singulair) would not usually be started in pregnancy BUT if you had been taking one of these medicines before you were pregnant and your asthma was well controlled, your doctor may advise that you continue as good asthma control is important during pregnancy.

If you have any concerns at all about the medications that you are taking or the level of your asthma control during pregnancy, please make an appointment with your doctor and seek appropriate medical advice.

If you find that your asthma symptoms are getting worse, make an appointment to see your GP or specialist. You may need a change in medication to control your symptoms. Sometimes you may need to see a respiratory specialist for follow up during your pregnancy.

Having an asthma attack whether you’re pregnant or not is ALWAYS a medical emergency. You need to seek medical advice immediately and either see your doctor or go immediately to the nearest Hospital Emergency Department.

Asthma in Children

Children who have asthma have sensitive airways. When they are exposed to triggers such as viral infections, cigarette smoke, animal fur, exercise or sudden temperature changes, the airways in the child’s lung become narrow and swollen, causing breathing difficulties. This is called an asthma attack.

During an asthma attack, three things happen in the asthmatic child’s airways:

  • The muscles in the walls of the airway contract, causing it to narrow.
  • Swelling occurs in the inner lining of the airway, making it even narrower.
  • Excessive mucus is produced inside the airway.

All these changes make the airways narrower, especially while exhaling, which makes it harder for the child to breathe.

The child may start to have a persistent cough, wheeze, or breathe faster, with increased effort. The changes that occur during an asthma attack are reversible, and can be improved with medical treatment. In between attacks, children often have no symptoms.

There is no known cure for asthma. However, with proper treatment and care, most children with asthma can lead normal lives, and take part in sports and physical activities like any other child.

Asthma is common. Up to 10% of school-age children have asthma, according to recent studies. Children with asthma may have some or all of the following symptoms and features:

Wheezing
The most common symptom seen in children with asthma.
Cough
More often in the night or early morning.
Breathing difficulty, fast breathing, chest tightness
These symptoms may be triggered by a viral infection, smoke or other factors as mentioned earlier, and can range from mild to severe.
Other associated conditions
Such as eczema (dry, sometimes itchy, sensitive skin), allergic conjunctivitis (dry, itchy eyes) or allergic rhinitis (frequent runny nose, sneezing and blocked nose after exposure to triggers such as dust or smoke).

During an asthma attack, your child may have some of the following symptoms:

  • Persistent cough
  • Wheezing
  • Fast breathing
  • Chest tightness, or difficulty breathing
  • Seem unusually tired, quiet, less active than usual
  • Unable to speak in sentences, because he or she is breathless
  • Nostrils dilating and contracting (nasal flaring)
  • Skin under the ribs, between the ribs and at the base of the neck being drawn in when he or she breathes

If your child has any of these features, and seems unwell, you should take him or her to see a doctor. If your child is very distressed or tired, you should take him or her directly to an Emergency Department. Severe asthma attacks may be fatal. 

Asthma attacks usually occur when a child is exposed to a trigger. The triggers differ, depending on the individual. One way to help reduce the number of asthma attacks is to avoid these triggers.

Common triggers for asthma in children include:

  • Viral infections. More than 80% of asthma attacks in children are triggered by infections of the lungs, nose and throat.
  • Sudden changes in temperature (e.g. moving from an air-conditioned room to a warm environment or vice-versa).
  • Dust, house dust mite, animal fur and other allergens.
  • Exercise. Physical activity can trigger asthma symptoms, but asthmatic children generally do not need to avoid exercise. They may take a kind of medicine, called a reliever, just before they exercise, to prevent or reduce asthma symptoms.
  • Cigarette smoke. This is a major asthma trigger. Children who are frequently exposed to cigarette smoke often have worse symptoms, more frequent and severe attacks and need more medication to control their asthma.

Some children with asthma need regular medication, called preventer therapy, to strengthen their lungs and help them stay free of attacks.

The treatment for asthma varies depending on the child’s symptoms, how often they occur and how severe they are. Generally, the goals of asthma treatment are to use the least amount of medication possible, to achieve good control of asthma symptoms and allow the child to live a normal, active life. 

The medication used for asthma can be divided into two types:

  • Reliever medication
    This is given to provide relief of asthma symptoms, by reducing the constriction of the airways. This makes the airways become larger, and lets the child breathe more easily. Reliever medication is given during attacks, and when children have asthmatic symptoms such as wheezing, cough or chest tightness. It is also sometimes given just before exercise.
  • Preventer medication
    This is given to children who have frequent or persistent symptoms, even when they are not having an attack. Preventer medication is taken every day, whether or not a child has an asthma attack. Over time, the medicine helps to make the lungs less sensitive, and reduces the risk of an asthma attack.

Asthma medication is usually given in the form of aerosols or powders that are inhaled into a child’s lungs. Most children need to take these inhaled medicines with the help of a device called a spacer. There are many different types and sizes of spacers. It is important to get one that is suitable for the child’s age, and to know how to use it and look after it properly.

With good asthma management and avoidance of triggers, most children will improve as they grow older. If treatment is successful, the child’s lungs should stay healthy, he or she should be able to participate fully in school and sports activities, and should have normal growth and development. With proper care, many children with asthma will not need regular medication by the time they enter adulthood.