2. Asthma management across ages Asthma in pregnancy Rule of one thirds (BTS/SIGN 2004)  1/3 improvement  1/3 worsening  1/3 stay the same

3. Asthma management across ages Asthma in pregnancy  Asthma needs to be monitored more closely during pregnancy  Medication concerns  Risks to fetus greater from poorly controlled maternal asthma

4. Asthma management across ages Asthma in pregnancy  Asthma medications should be continued during pregnancy and modified to control symptoms  Reassurance of safety of asthma treatments is essential

5. Asthma management across ages Asthma in pregnancy Midwives  May not be familiar with asthma drugs or appropriate management  They need support to help manage asthma so that treatment is not stopped unnecessarily  Asthma training issues for midwives to be addressed

6. Asthma management across ages Asthma in pregnancy  Asthma is treated in exactly the same way  Exception LTRAs should not be started during pregnancy (limited evidence for safety)  LTRAs can be continued during pregnancy if they have contributed to significant improvement in asthma control (BTS/SIGN 2004)  If oral steroids are required for poorly controlled asthma they should not be withheld because of pregnancy

7. Asthma management across ages Asthma in pregnancy During delivery  Asthma attacks Rare due to large amount of endogenous circulating steroids  If oral steroids > 7.5 mg/day > 2 weeks  give 100 mg parenteral Hydrocortisone every 6-8 hours during labor

8. Asthma management across ages Asthma in pregnancy Breast feeding  Encourage breast feeding  Asthma treatment taken normally  No clinical significant risk of Prednisolone: minimal concentration in breast milk (BTS/SIGN 2004)

9. Asthma management across ages Asthma in pregnancy Smoking  Pregnant should not smoke  More important for those who have asthma to cease smoking  Need advise and support to help them stop  NRT is not advocated in pregnancy But balance benefits and risks