Division of Rheumatology, Allergy and Clinical Immunology; Department of Internal Medicine, University of California, Davis, School of Medicine, Davis, CA, USA.
Clin Rev Allergy Immunol. 2012 Aug;43(1-2):45-56. doi: 10.1007/s12016-011-8277-8.
Asthma is probably the most common serious medical disorder that may complicate pregnancy. A third of pregnant women with asthma will experience worsening of their symptoms, a third will see improvement of their symptoms and a third will see no change. The primary goal is to maintain optimal control of asthma for maternal health and well-being as well as fetal maturation. Vital patient education should cover the use of controller medication, avoidance of asthma triggers and early treatment of asthma exacerbations. Proper asthma management should ideally be started in the preconception period. Since smoking is probably the most modifiable risk factor of asthma, pregnant woman should avoid active and passive smoking. Acute asthma exacerbation during the first trimester is associated with an increased risk of congenital malformations. Poorly controlled asthma is associated with low birth weight, preeclampsia, and preterm birth. Medications used for asthma control in the non-pregnant population are generally the same in pregnancy with a few exceptions. Inhaled corticosteroids (ICS) are the preferred controller therapy. Budesonide is the preferred ICS. Long-acting B-agonists (LABA) are the preferred add-on therapy to medium to high dose ICS. Major triggers for asthma exacerbations during pregnancy are viral infections and ICS nonadherence.
哮喘可能是最常见的严重医学疾病，可能会使妊娠复杂化。三分之一的哮喘孕妇会出现症状恶化，三分之一会出现症状改善，三分之一则没有变化。主要目标是为了母亲的健康和福祉以及胎儿的成熟，保持哮喘的最佳控制。重要的患者教育应包括控制药物的使用、避免哮喘诱因和早期治疗哮喘恶化。理想情况下，应在备孕期间开始进行适当的哮喘管理。由于吸烟可能是哮喘最可改变的危险因素，因此孕妇应避免主动和被动吸烟。妊娠早期急性哮喘恶化与先天畸形风险增加有关。哮喘控制不佳与低出生体重、先兆子痫和早产有关。非妊娠人群中用于哮喘控制的药物在妊娠期间通常相同，只有少数例外。吸入皮质类固醇（ICS）是首选的控制治疗药物。布地奈德是首选的 ICS。长效β-激动剂（LABA）是中至高剂量 ICS 的首选附加治疗药物。妊娠期间哮喘恶化的主要诱因是病毒感染和 ICS 不遵医嘱。
