Managing Asthma While Pregnant
For women with asthma, pregnancy can pose an extra challenge. Sound Medicine contributor Erika Beras reports on precautions that expecting moms can take, that protect their health…And their baby’s.
Beras: On a recent afternoon, Kelly Liartis is at Magee Women’s Hospital for a check-up. She’s talking to her doctor Hyagrive Simhan about her soon to be born baby -- and her frequent summer asthma flare-ups.
Kelly: So just out of curiosity and then Alburitol is not ok? It is ok. Does it speed their heart rate up at all?
Beras: For the 10 to 12 percent of Americans with asthma, flare-ups mean their airways can get inflamed and then narrow – constricting breath and sometimes causing wheezing or coughing. A flare-up can be triggered by exercise, smoke, dust – or in Kelly Liartis’s case, hot muggy summer days. In Southwestern Pennsylvania, there is a higher prevalence of asthma and asthma hospitalizations than in other parts of the U.S. Her doctor Hyagrive Simhan, Chief of Maternal Fetal Medicine at Magee says its not completely understood why that is.
Dr. Hyagrive Simhan: Many of the factors for asthma are prevalent in this area. So particulate air pollution, smoking, obesity, nutritional contributors to asthma are more common here and the presence of those risk factors tends to increase its frequency in general in the population. And we see the same thing in pregnancy.
Beras: Increasing scientific evidence also points to a big part of the puzzle, the air quality. When the American Lung Association releases its annual State of the Air report, the Pittsburgh metropolitan region always ranks high on the lists of most polluted cities – whether looking at ozone, year-round particle pollution or short-term pollution. But historians and doctors say that’s nothing compared to the region’s past as ‘the smoky city’– where as the famous anecdote goes, downtown street lights would come on mid-day because of the smog, soot and smoke in the air.
Joel Tarr: That soot was in the air all the time and there was dustfall and supposedly you’d park your car out at night and in the morning you’d clean the grit off of the car.
Beras: That’s Joel Tarr, an environmental historian at Carnegie Mellon University.
Joel Tarr: They had a hard time over the years linking up smoky air and air pollution per se with health issues but the common sense knowledge was yes, your coughing all the time, this is not good for your health.
Beras: Dr. Hyagrive Simhan says asthma was prevalent then, but the ways of treating it weren’t quite developed.
Dr. Simhan: Severe asthma, years and years ago, generally precluded individuals from getting pregnant. The medications that were used to control asthma were far fewer, and if an individual had severe asthma and needed oxygen therapy and lots of hospitalizations and infections, it was far less common for those individuals to reproduce. We have because medications and strategies helped women through the pre-reproductive years reducing oxygen, keeping them in general healthier. We see many more asthmatic women getting to the point of becoming pregnant than I suspect we would have seen 50 or 75 years ago
Beras: When asthmatic women get pregnant, it can go several ways says Fernando Holguin, Assistant Director at the UPMC Asthma Institute.
Fernando Holguin: We call it the rules of 3 – if a woman has asthma and gets pregnant, her asthma can get better, remain the same or get worse.
Beras: Some of the drugs used to treat asthma are considered Class C or above – meaning the risks to a fetus are unknown. It's suggested pregnant women don’t use them but Hyagrive Simhan says not controlling asthma can also be risky.