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Managing asthma in pregnancy

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The British guideline on the management of asthma was updated and published in October 2014.1 This article looks specifically at the implications for women with asthma who are planning a pregnancy.

Jennie is a 25-year-old accountant and comes to see you for an asthma review. She has good control of her asthma with a dry powder device combination inhaler of an inhaled corticosteroid (ICS) and long-acting beta agonist (LABA) used twice daily. She rarely needs to use her short-acting beta agonist.

She tells you that she is planning to become pregnant and wants to know whether she should stop her medication and what is likely to happen to her asthma during pregnancy. Jennie hopes to continue to work for as long as possible and is hoping to breastfeed. What advice do you give her?

It would be worth clarifying with Jennie whether she takes any other medication (OTC and prescribed). Ask about the outcomes of any previous pregnancies and how her asthma was during these. The new guideline suggests that asthma will usually follow a similar pattern to previous pregnancies.

If Jennie is a smoker, she should receive appropriate brief interventions and support to help her to quit.2 The evidence against smoking in pregnancy is strong and it carries many risks (Box 1).3

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