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Treatment of asthma during pregnancy: more solid evidence needed

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In this issue of Thorax, a paper by Tata and colleagues1 assesses the association between maternal asthma and gestational exposure and asthma medications with the risk of congenital malformation in offspring using The Health Improvement Network primary care database (see page 981). Their findings showed that gestational exposure to commonly used asthma medications seems to be safe, although a moderate teratogenic risk of cromones cannot be excluded. This is important information for many doctors, mainly pulmonologists and allergologists involved in the treatment of asthma in pregnant women. It indicates that we can approach the pregnant patient with asthma in the traditional manner, without major concerns and using all the available treatment options with the exclusion of cromones which, in any case, currently represent an unusual therapeutic choice.

The results of this study enable us to reassure our pregnant patients. We have all found that one of the most complicated aspects of the work of a chest physician is to convince a pregnant patient with asthma to adhere to prescribed therapy. Several surveys have shown that women decrease and/or stop asthma medications during early pregnancy, probably because they are concerned about the safety of asthma medications during pregnancy.24 Conversely, physicians appear to be reluctant to prescribe asthma medications for pregnant women. A multicentre study found that pregnant women with asthma were significantly less likely to be prescribed corticosteroids in the emergency department: only 44% of pregnant women were treated with corticosteroids compared with 66% of non-pregnant women.5 Those who were admitted to hospital were less likely to be treated with corticosteroids at discharge and were almost three times …

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  • Competing interests: MC has received fees for speaking and consulting and/or financial support for attending meetings from Abbott, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, Dey, Encysive, GSK, Keryos, Lallemand, Menarini Farmaceutici, Novartis, Nycomed, Pfizer, Sanovel and Valeas. MGM has received fees for consulting and/or financial support for attending meetings from AstraZeneca, Boehringer Ingelheim, Encysive, GSK, Novartis and Pfizer.

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