About two-thirds of pregnant women with asthma experience changes in asthma symptoms or severity during pregnancy. Uncontrolled asthma can lead to reduced fetal oxygenation and is associated with increases in the risk of preeclampsia, perinatal death, premature birth, and low birth weight.

Both mother and fetus benefit from aggressive management of maternal asthma, according to updated recommendations from the National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung, and Blood Institute. Because of information revealed by studies conducted after 1993, when the guidelines were originally released, the NAEPP convened a panel of experts to review the literature on asthma medication use during pregnancy.

The panel determined that exposure to certain medications is safer for the fetus than diminished oxygen levels resulting from uncontrolled maternal asthma; they developed an approach to treatment that focuses on monitoring asthma severity, managing asthma triggers, patient education, and a "stepwise approach" to drug therapy.

Acute exacerbations.

An action plan for managing severe acute exacerbations is essential, and the woman must have the medications she needs to begin treatment and the knowledge to recognize when to use them. She also needs to know when to seek emergency care.

Generally, the same medications are used in an exacerbation as are used in chronic asthma care, but in higher doses at shorter intervals or by a more rapid route of administration, requiring careful monitoring and supervision. Short-acting [beta]₂-agonists can be given by nebulizer. Corticosteroids can be given intravenously rather than orally. The use of epinephrine is discouraged, since there are no data to support it.-Fran Mennick, BSN, RN