Asthma diagnosis and treatmentNAEPP Expert Panel Report: Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment—2004 Update
Section snippets
Systematic review of the evidence
A systematic review of the evidence on the safety of asthma medications during pregnancy was conducted by drug class. Of 226 articles retrieved in the search of literature published in peer-reviewed journals from January 1990 through May 2003, 42 met criteria for inclusion in the evidence review; 2 additional articles published after May 2003 were included, for a total of 44 articles. A summary of the findings from the evidence, arranged by medication category, follows.
Recommendations for managing asthma during pregnancy
The Working Group recommends the following principles and stepwise approach to pharmacologic therapy for managing asthma during pregnancy. (See Fig 1, Fig 2, Fig 3, Fig 4, Fig 5, Fig 6.) The principles and approach are based on the Working Group's interpretation of the current scientific review of the evidence on the safety of asthma medications during pregnancy and consideration of previous NAEPP reports: the Asthma and Pregnancy Report 1993, the EPR-2 1997, and the EPR—Update 2002.
Recommendations for pharmacologic treatment of asthma during pregnancy
Stepwise approach for managing asthma. To develop recommendations for the stepwise approach to the pharmacologic treatment of asthma in pregnant women, the Working Group first considered the stepwise approach in the EPR—Update 2002, which was based on systematic review of the evidence from medication effectiveness studies in nonpregnant adults and children. The Working Group also considered EPR-2 1997 and the Asthma and Pregnancy Report 1993.
The effectiveness of medications is assumed to be the
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Disclosure of potential conflict of interest: W.W. Busse has consultant arrangements with Bristol-Myers Squibb, Dynavax, Hoffman LaRoche, Fujisawa, and Wyeth; receives grants/research support from GlaxoSmithKline, Fujisawa, Aventis, Hoffman LaRoche, Pfizer, and Wyeth; is on the Speakers' Bureau of GlaxoSmithKline, Aventis, and Merck; and is on the Advisory Board of GlaxoSmithKline, Aventis, Schering, Pfizer, and AstraZeneca. M. Cloutier received an Easy Breathing Educational grant and receives grants/research support from GlaxoSmithKline. M. Dombrowski—none disclosed. H.S. Nelson has consultant arrangements with Rigel Pharmaceuticals, Dey Laboratories, GlaxoSmithKline, Altana, AstraZeneca, Aventis, Integrated Therapeutics Group, UCB, Genentech, Protein Design Laboratories, Dynavax Technologies, and Wyeth; receives grants/research support from Dey Laboratories, IVAX, Eli Lilly, Altana, Epigenesis, and AstraZeneca; and is on the Speakers' Bureau of GlaxoSmithKline and AstraZeneca. M. Reed has consultant arrangements with Abbott Laboratories, Bristol-Myers Squibb, Enzon, GlaxoSmithKline, Pfizer, and Somerset; receives grants/research support from Abbott Laboratories, AstraZeneca, Aventis, Bristol-Myers Squibb, Eli Lilly, Forrest Laboratories, GlaxoSmithKline, Janssen, Johnson & Johnson, Merck, Novartis, Organon, Pfizer, Roche, Schering, Somerset, and Wyeth-Ayerst; and is on the Speakers' Bureau of Abbott Laboratories, Bristol-Myers Squibb, Enzon, GlaxoSmithKline, Pfizer, Roche, and Somerset. M. Schatz receives grants/research support from GlaxoSmithKline and Aventis and is on the Speakers' Bureau of Merck and AstraZeneca. A.R. Scialli—none disclosed. S. Stoloff has consultant arrangements with GlaxoSmithKline, AstraZeneca, Schering, Aventis, Genentech, Alcon, and Pfizer and is on the Speakers' Bureau of GlaxoSmithKline, AstraZeneca, Schering, Aventis, Genentech, Alcon, and Pfizer. S. Szefler has consultant arrangements with AstraZeneca, GlaxoSmithKline, Aventis, and Merck and receives grants/research support from Russ Pharmaceuticals and AstraZeneca.