Expert: Marc Rubin, RPh Asthma Educator - 1/18/2010

Question
Hi,
 I am not yet pregnant, but I would like to know if asthma meds are safe to take while pregnant. I know that the benefits usually outweigh the risks, but for some reason, I don't like the idea of taking meds while pregnant. I have asthma, and when I was pregnant with my first child, my asthma slowly got better during the 1st trimester, and generally stayed that way, with me having to use my inhaler only during a really bad cold. I would like to know if asthma meds are safe, and if so, which ones would you recommend while pregnant. After I gave birth, I was virtually asthma free, but a year later, my asthma and allergies came back. I am now on Flovent 100 mcg once a day, and Nasonex, 2 sprays, twice a day. Since I am allergic to dust, I vacuum every other day, mop the floors daily, and clean the house fairly well. I literally don't know what else to do, as I still find myself wheezing when I go to sleep and when I wake up, and sometimes during the day. Any advice would be appreciated. Thank you.

Answer
Hi Sasha,

On the safety concern of risk/benefit, maintaining the high functionality of your lungs is a must.  To begin with, your rescue inhaler, generally one of the branded albuterols, is a generally a non-issue, since if you have an attack which reduces your oxygen levels, prolonged lowered levels will have an impact on the fetus. That being said, Atrovent-HFA, a rescue drug in a different chemical category is actually safer, but somewhat slower to work. The asthma guidelines to call for the use of albuterol in pregnancy, so if that is what you are on, stick with it for rescue.

If you need to be on a steroid controller medication, the best one is Pulmocort, it has a higher safety factor than the other agents, such as Flovent or Asmanex.

If you do not maintain adequate control with just Pulmicort, the next appropriate add-on would be Singulair. It is rated at the same safety level as Pulmicort

The long-acting bronchodilators, such as Foradil or Serevent, which are also found in Advair and Symbicort should be used IF you do not achieve adequate control with Singulair added to the Pulmicort.

Regarding the nasal sprays, the medication in Pulmicort is also in Rhinocort-Aqua. Nasonex is rated lower.

Should you need an antihistamine, the single choice would be Zyrtec, which is rated higher than Allegra or Clarinex.

Now here is the final point, the actual rating system:

A: controlled studies in pregnant women fail to show a risk to the fetus in any of the trimesters, and harm appears to be remote. None of the above drugs fall into "A".

B: Although there are no controlled studies in pregnant women, studies in animals have not demonstrated fetal risk, and the only potential adverse effect that may happen is decrease in fertility. With the exception of albuterol, all my other recommendations are "B".

C: Either studies in in animals haved revealed adverse effects, and there are no controlled studies in women, or studies in in women and animals are not available.. So the drugs should be given only if the potential benefits justify the potential risk to the infant. Albuterol is a "C", as well as the other asthma meds you are on. But in the case of albuterol, it is only being used as rescue, not a daily medication, so your exposure is hopefully very limited. Advair and Symbicort are also "C", as are Allegra and Clarinex.

D: Positive evidence of fetal risk. May be acceptable in life-threatening situations.

X: High risk during pregnancy. DO NOT USE


Hope this helps you!

Good luck :)

Sincerely

Marc