Are asthma inhalers and medication safe when pregnant?

Doctor's advice on how to safely use an inhaler and asthma drugs

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In a nutshell

Most asthma inhalers are safe during pregnancy and breastfeeding, but check with your GP

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The expert view

The NHS advises that the best way to keep your asthma under control and to stay healthy during your pregnancy is to stick to your asthma treatment plan. This means speaking to your GP for advice on your asthma as soon as you find out you are pregnant.

If your asthma is well controlled, there is little or no risk of bad outcomes for you or your baby.

There is also no predictable pattern as to how your asthma symptoms will be affected by pregnancy. The NHS currently states that about a third of pregnant women with asthma find their symptoms improve during pregnancy, a third will have worse asthma, and a third will stay the same.

“Some women find that their asthma improves during pregnancy anyway as pregnancy is a steroid-producing state and many of the medications used for asthma contain steroid,” explains MFM’s GP Dr Philippa Kaye.

Uncontrolled asthma during pregnancy could mean that less oxygen is delivered to your blood, and it’s from here your developing baby get their oxygen supply.

Poorly controlled asthma increases the risk of a premature birth, or the baby being too small, even if born at full term.

It also increases the risk of pre-eclampsia, where the main symptom is very high blood pressure that can be dangerous for the mother and baby.

Asthma drugs

There are several kinds of asthma medication, so it’s worth knowing how they differ.

“The most commonly used inhalers are salbutamol and steroid inhalers, which are safe in pregnancy but, as with all medications, please do check with your doctor,” urges Dr Kaye.

Asthma inhalers

Inhalers deliver the medicine directly to the airways and lungs, so a much smaller amount of the drug is needed than using tablets.

Drugs inside inhalers can be grouped into relievers (bronchodilators), preventers (steroid inhalers) and long-acting bronchodilators – these are generally all considered safe in pregnancy.

Relievers – used when you are breathless, wheezy or tight-chested, the two main reliever drugs are salbutamol and terbutaline, often known by their brand names Airomir, Asmasal, Salamol, Salbulin, Pulvinal Salbutamol, Ventolin. and Bricanyl.

Preventers – glucocorticoid steroid inhalers are considered safe to use, but you may have read they have been linked to birth defects.

This came about after a Danish study found that there was a slightly increased risk of children developing metabolic or hormonal disorders, when researchers examined a whole range of childhood diseases.

However, they have been widely studied and are considered safe, when bearing in mind the risks of not controlling asthma.

They include the drugs beclometasone, budesonide, ciclesonide, fluticasone and mometasone, with brand names such as Asmabec, Beclazone, Becodisks, Easyhaler Budesonide, Flixotide and Asmanex Twisthaler.

Long-acting bronchodilator inhalers

The drugs in these inhalers work in a similar way to relievers, but work for up to 12 hours after taking each dose. They include salmeterol (brand name Serevent) and formoterol (brand names Atimos, Foradil, and Oxis).

Asthma tablets are also normally considered to be safe during pregnancy.

The main exception is one group of asthma medicines that wouldn’t normally be started during pregnancy called leukotriene receptor antagonists (Montelukast or Zafirlukast).

However, if you were taking Montelukast/Zafirlukast before you became pregnant, and it’s working well for your asthma, you will probably be advised by your GP to continue taking it.

Mums on our forum say

“Have had asthma for years and have always suffered in pregnancy due to hormonal changes and the baby taking up more space. I have always been under an asthma nurse at my local GPs and have always taken both of my inhalers.

The brown one is especially important as it is a preventer – no steroids in it. but the blue one does have as it is a reliever. It is very important that you take your brown one as prescribed to help prevent wheeziness and your blue one when needed for relief of tightness in your chest.

‘It doesn’t pass to the baby at all, in fact it is better to take them and be able to breathe properly than to not take them.” – pen 37297

“I take Flixotide(Becotide and Becloforte not strong enough) and have been advised by both my own GP and the specialist I have been seeing (and I just met with her again yesterday) to definitely continue throughout pregnancy.

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“They said that the does was so small and due to the way it is administered it is unlikely that any at all would even reach the baby. Becotide is one of the ones so commonly used, I am sure it is fine.” – Excitedmum2b

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