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Pregnancy Complications

Maternal Diseases and Pregnancy

Asthma During Pregnancy
By Barbara Parker, RN, ARNP, CNM

Q. I have asthma and have been using Flovent (220mcg) as needed. I was on Theodur, flovent and combivent, but stopped them when we started trying to conceive.

My asthma was doing really great until about 18 weeks and I had to go back to the Flovent. I find myself having to use more and more each day like 4-6 puffs as opposed to 1am and 1pm.

Now I am 26 weeks and my chest is very 'heavy' with lots of coughing at night, wheezing, shortness of breath and congestion with backache. I know these are all the signs of what may come. My peak flow is 350 (400-450 is as good as I get), so all the signs are a bit contradictory to the peak flow. Should I be concerned or even getting a breathing treatment? I hate the thought of a treatment, isn't that really bad for baby? Should I be asking about Theodur or anything other than treatment? Also, how can I tell if my baby is getting enough oxygen?

A. As long as YOU are breathing, your baby is most likely getting enough oxygen! One of the most important principles in obstetrics is that you can't have a healthy baby without a healthy Mom, and breathing is not an optional activity.

Asthma is generally made better by pregnancy--the high levels of progesterone cause smooth muscle relaxation (smooth muscle tissue is in the airways AND uterus). However, that doesn't mean you can't have bad flare ups and real problems with it.

Let's talk for a minute about Asthma meds--there are 2 basic kinds--first the maintenance or preventative meds: Serevent, Flovent, Theo-dur, and so on, the meds that try to keep symptoms under control. Second is the rescue med--what you use when you are having an acute attack---that would be a bronchodilator, like albuterol, proventil, maxair.

You need to review your meds with your doctor or midwife. I have it on good authority (the asthma/allergy doctors I send all my patients to) that these meds are all safe in pregnancy--after all, as I said, breathing is NOT an optional activity!!!

You also need to consider the possibility there is something triggering the increased problems--do you have a sinus infection? Are your underlying allergies controlled? Those problems MUST be addressed in order to get control of your asthma.

Last, anxiety plays a big part in this too. Not being able to breathe is a VERY anxiety-producing experience! And the more anxious you get, the harder it is to breathe, and so on, and so on. It becomes a vicious circle!

See your health care provider and get control of this. The meds you need are more important to your health, and we need to keep you well-oxygenated in order to have a healthy baby!!!

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