Asthma during Pregnancy

Archived Q&A and Reviews

Have you taken Advair while pregnant?

April 2006

I have read the archives about taking various asthma medications while pregnant but don't see a relatively new med, Advair (Class C), discussed. My asthma is generally mild but is starting to get out of control. Normally I would take a course of Prednisone to get in back under control but I am 6 weeks pregnant. I called my OB who said not to take Advair unless ''absolutely necessary'' and to ask my asthma specialist for a Class B alternative. My asthma doc said Advair is what I should take and it is ''totally fine'' while pregnant and was very blase about it. From what I can find on it, it is too new and they don't know the effects on unborn children. Of course, me breathing is most important for my child but there must be other meds to take. Has anyone taken Advair while pregnant or been switched to something else? I take Albuterol as needed but because that is becoming increasingly frequent, I know I am spiraling out of control. I have never been in a situation where docs contradict each other but where the stakes could be high. Wheezer

Just today my doctor and I discussed this because we have one child and are hoping to have another not long from now. He said, first and foremost, that the mother needs to get adequate oxygen and asthma attacks are more immediately threatening to mother and child than asthma medicine. No one really does pregnant human trials anymore so drugs are category B at best. He said that Advair has two different ingredients, and other drugs like Asmanex (which he prescribed for me) have the same class of asthma preventative as Advair but without the second ingredient in Advair that is a long-acting bronchio-dilator that isn't needed if the first ingredient does its job to get things under control. anon

You should definitely be taking Advair during your pregnancy. I have for both of my recent pregnancies. As you say, getting air to your baby and keeping your breathing good is your most important task. Advair hasn't been around that long but the underlying meds have been, and there are no known effects. My docs had me switch off other newer meds for other issues but kept me on the advair. It's much better than albuterol, as you want to control the asthma before it starts. Have your OB speak to a pulmonologist if he or she is concerned. Sabrina

Regarding using Advair during pregnancy, I used it when I was pregnant with my twins 6 1/2 years ago, so it's not really all that new. In addition, Advair is simply the inhaled steroid found in Flovent combined with Serevent, so the drugs used in Advair are quite old and well tested. I'd use it without hesitation and would certainly consider it far safer than untreated asthma, frequent albuterol, or an oral course of prednisone. Very little of the drugs make it out of the lungs, unlike prednisone. I've had severe asthma all my life and would be happy to answer any other questions you have. Erin

I too am pregnant and my asthma has been worse since the beginning of my pregnancy. First I tried to deny it and avoided taking Albuterol, then I realized how dangerous it was to deprive myself and my baby of adequate oxygen. I am a RN and did some reading in my drug books. I found that Pulmicort, a daily preventitive medication, like Advair, is considered safe. It is a corticosteroid, but the inhaled version is a Pregnancy Category B drug. Advair, like Albuterol, is a category C drug. Albuterol has been around much longer than Advair, and seems to be considered safe for pregnant women, but probably has not had enough studies done to prove its safety as a category B drug. As you wrote, Advair is a newer drug so it made me uncomfortable to take it. My doctor also suggested Advair and assured me it was okay. But I told her that I prefered to try the Pulmicort, if for no other reason then to not feel stress or worried. The Pulmicort did work for me and I was able to cut back on my Albuterol use. I have also become more vigilant during my pregnancy to avoid my asthma triggers, such as homes with cats, having my husband do the dusting and vacuuming frequently and washing my bedding more often. In the end, breathing comfortabley for you and your baby is the ultimate goal and you and your doctor will have to work as a team to achieve it. breathing easier

For what it's worth, there is a class B inhaled corticosteroid, Pulmicort. For anything beyond that, and if you'd consider switching doctors, I'd recommend talking to Allyson Tevrizian with the Allergy & Asthma Medical Group of Diablo Valley. (Berkeley office is 510-644-2316) She's a mom herself, and up on what's safe and not in pregnancy--she could advise you much better. fellow wheezer

Albuterol is a smooth muscle relaxer, as well as a bronchiodilator -- my OB (and 1991 one) pointed out to me that he had in the past prescribed it to help stop early contractions... and that it was also good for asthma. It has a long history of use in pregnancy without serious side effects. Please don't hesitate to use albuterol as needed for asthma while pregnant.

As you have pointed out, the MOST crucial issue is to breathe well -- as the ALA motto says ''When you can't breathe, nothing else matters.''

Unlike prenatal nutrition -- in which your baby will take what s/he needs and leave you whatever's left -- s/he ONLY gets enough oxygen if you are getting enough yourself.... any oxygen deficit will first effect the baby.

Obviously you want to take the most benign meds that will effectively control your asthma, but controlling the asthma is crucial. Another doctor, or reading the Internet info on Advair may calm your fears. If not, go ahead and demand to be changed to another, more established, medication. Why worry, when you can relax?

Good luck, I took asthma medications throughout my pregnancies... and while my kids are a little odd... I'm pretty sure its just a personality issue! Heather

I have asthma and was ''high risk'' during pregnancy as a result. I have tried everything under the sun and only take prednizone (can't remember how to spell it) when I get really sick or something. That drug is wonderful for 1 week and evil long term. Advair has been my saving grace. I think your doctor is crazy. I had a wonderful high risk doctor named Paula Melone in Walnut Creek. Is is truly outstanding. I have 3 other success stories with this doctor to share with very high risk situations. She told me it was fine, lack of oxygen and sleep is not healthy and albuterol and advair in low amounts just light and normal use is fine. My daughter is now 6 years old and couldn't be more healthy.

About Albuterol and Advair during pregnancy. With my first pregnancy, I only had to do Albuterol about three times during the pregnancy. He is 3 years old now and does have asthma, we just recently & reluctantly started him on Pulmicort everyday.

And just like you, I have been getting increasingly worse, so this pregnancy, I've had to be on Advair the entire time and I've done Albuterol about 5 times during this pregnancy. I'm a couple weeks away from delivering, so I'm not sure how things will turn out with the 2nd, everything seems fine so far. I'd love to keep in touch and let you know.

My doctors, both my general practioner and my OB both say Advair and Albuterol are fine. I was even on Flonase (a nose spray) during most of the pregnancy.

I am usually very reluctant to take any sort of medications, pregnant or not. But after watching my son have a few wheezing attacks, I've decided using the drugs are much better than going through those attacks, so we are using preventative meds now with our 3 year old. My husband has great health, I was hoping our kids would get that from him. So, not many answers, but that's my experience so far. gina

I talked to various drs during my pregnancy and they all assured me that albuterol is fine. The alterative - not being able to breath properly - is definitely unhealthy and untenable for both you and your baby. I used albuterol and have a beautiful and healthy baby. With all the things to worry about, I think you can cross this off your list. emilym

My asthma also got worse when I was pregnant--to the point where I was using my albuterol 2-3 times a night. My allergist put me on salmeterol. It was great. I was able to sleep through the night and probably used my albuterol a couple of times a week. Salmetoral (serevent) is the bronchodilator that is part of what you get when you take Advair (the other portion of advair is the steroid). Salmeterol has a much longer 1/2 life than albuterol and that's why I was able to go 12 hours or more without needing another puff. My allergist didn't recommend Advair to me then, but I take it now, since my asthma seems to be slowly getting worse the longer I live. denise

I have had asthma most of my life. It got worse after I had my kids. I have worked with Chinese Medicine, Homeopathy and Anthroposophic Medicine. From what I have learned Albuterol is the least invasive as it tends to stay mostly in the lungs. Western doctors tend to want to take you to the next level if you use it a lot but my Anthroposphic doctor tells me to use it as much as I need - the only side effect is rapid heart beat which can be annoying. One of the other pieces of advice he gave me was to go to bed earlier and get more rest. I have also found yoga to be very helpful and strengthening. Jill

Take your Advair/Albuterol/Proventil, etc. The way my doc explained it is like this: If you're not getting oxygen, your fetus is getting even less. I took mine all through my pregnancy. No problems. -- Tsan

My OB says Albuterol only for emergencies

March 2003

Hi everyone, I'm hoping someone can give my some advice on how to deal with my asthma during pregnancy. My regular dr. said my Albuterol inhaler was perfectly safe, but my OB disagrees and feels that while it's better (obviously) than not being able to breathe, it certainly does cross the placenta and should be used in emergencies. I don't have terrible attacks of asthma, just shortness of breath and wheezing, but I know it will get worse during the rest of my pregnancy. I'm hoping for some natural or homeopathic remedies or preventative advice. Thanks so much! Wheezy Mom

I'm deeply concerned that your OB would do anything BUT encourage your albuterol use in pregnancy. I STRONGLY suggest you talk to a doctor who understands the relationship between albuterol and the fetus AND breathing and the fetus. Albuterol should be on his formulary as a smooth muscle relaxer (sometimes used to avoid preterm labor) and has no discernible side-effects except to increase the oxygen flow to both you and your fetus. I have had three healthy happy pregnancies on albuterol and a host of other medications (theophylline, inhaled steroids, etc) to combat fairly serious asthma. You can contact me if you want to talk about this some more.

My suggestion is to do EXACTLY what you have been doing, if it was working, and to get a second opinion. Remember that your child can steal nourishment from you if you fail to eat, but can only receive the oxygen that comes through your system...please be careful. Your asthma may get better or worse through this pregnancy, but will return to ''normal'' after birth and/or breastfeeding. Heather

I am now in my third pregnancy with asthma. My asthma, like about 1/3 of women, tends to get worse during pregnancy -- especially during the later stages when the lungs are being pressed by the baby. Your OB sounds very out of touch about asthma treatment during pregnancy. Although SMALL AMOUNTS of inhaled medication do pass through to the baby, these medications (at least most of them ) are category B medications -- e.g., the same category as the air we breath and the water we drink. Safe during pregnancy. It's essential for your baby that you breathe well during your pregnancy. I'd suggest you ask your primary care physician for a referrel to a pulmonologist for your pregnancy. I saw a great woman at Berkeley Pulmonology at Alta Bates -- Dr. Kury, a woman who has special expertise in ashtma during pregnancy. It sounds like you would be better off with more preventative meds than it sounds like you're on now. Expert advice at this point can help and perhaps you can work on informing your ob. I got very bad advice (use as little meds as you can stand for asthma) during my first pregnancy that left me miserable and struggling for breath and my baby in danger. Get better advice. sabrina

I too have mild asthma and allergies and did when I was pregnant two years ago. My asthma was not always active, but when it was I had mild wheezing and a tighness in my chest. I used my albuterol inhaler, but only when I felt it was necessary and even then just one puff every 4-6 hours. My health care provider considered this safe (you have to breathe in order to live and provide enough oxygen to your baby!). I tried homeopathics for my conditions, but they did not seem to work well for me. In the past two months I have begun seeing a practioner of Traditional Chinese Medicine at Meiji College of Oriental Medicine in Berkeley. I've had wonderful results!! (This includes herbs, diet modification and accupunture.) Also, you might want to consider Chiropractic care- try Dr. Aaron and Dr. Eileen at Upaya Center for Wellbeing near Lake Merrit. They practice network chiropractic (so gentle! All asthma is exacerbated by stuff in the air, even if you're not allergic to that stuff, as I'm sure you know... so try mattress and pillow covers too, if you haven't already. You can get them in all cotton online. Good luck and feel free to contact me if you'd like! Laura G.

I have never been pregnant, but I have had asthma for years. If you are using Albuterol more than a few times a week, you should probably consider a different protocol. I was in that place for several years, and I am so much healthier and have so much more freedom of movement since I switched to a daily long-acting bronchiodilator and inhalable steroid (Serevent and Flovent). That said, I am also concerned about whether these meds cross the placenta and affect the child during pregnancy. Anyone know the science on this? Janey

I would question your OB's recommendation. Breathing well is so important during pregnancy! I have asthma, and when I was pregnant 3 years ago, in my first trimester, I got 2 upper and lower respiratory infections in a row. I was on 2 different antibiotics, and couldn't seem to get my asthma under control. It was my OB who sent me to my pulmonologist.

The pulmonologist really opened my eyes. He said asthma needs to be properly managed during your pregancy. Your body needs more oxygen for the baby's development. A big warning sign is if you need to use your inhaler at night. Heartburn can also be worse with asthma, and he recommended handfuls of Tums, plus elevating the head of the bed.

Albuterol is OK during pregnancy -- it's the same drug as terbuteline that they give women with premature labor. But it might not be enough. There are other medications that can safely be used along with albuterol to reduce the inflamation of the lung tissue. My pulmonolgist's name is James McFeely, and he's part of Alta Bates Medical Group.

Hope that helps. Good luck. Mollie

I have episodic asthma which was more pronounced during my pregnancy. Maybe it would be helpful to contact the La Leche League. I believe they have resources about which drugs can pass through to the placenta as well as which ones can cross into breastmilk. If albuterol isn't safe, maybe one of the other bronchiodialators are. Or one of the daily preventative medications, like Singulaire, might would work for you. Good luck! JT

Please consider getting yourself a new O.B. His advice isn't going to help you or your baby.

You need the maximum oxygen possible while you're growing this miracle inside you. And your baby needs oxygen to grow, too! Wheezing, even a little, is unacceptable while pregnant. And putting it off till it's an emergency could compromise the health, or even the life, of your baby. The use of albuterol to stave off a grave asthma attack is supported by most doctors. Did you know that for asthmatic moms who become pregnant, about 1/3 have less asthma, 1/3 stay the same, and 1/3 get worse? It sounds like you might be in the last category. Please don't fool around with this. It could have awful results. Hug, Jennie, an asthmatic mom

I had severe asthma both before and during my pregnancy with my now 6 year old son. I took many more medications than just an inhaler. I researched all the medications I took before my pregnancy and discussed my concerns about them with my OB/GYN. Although they can pass to the child, my OB/GYN stressed that it is much more important that I be able to breath while I was pregnant than the small risks my meds might have on my unborn child. I feel that you need to discuss your asthma with your OB/GYN. Maybe he/ she is unware of how severe uncontrolled asthma can be in pregnancy. If necessary, get your reular practitioner to discuss this issue with your OB/GYN. Trying to find alterntive treatments during pregnancy could be risky. There certainly are alternative treatments for asthma (I have tried several), but just because something is ''herbal'' or alternative may not mean it is risk free. Starting something new while pregnant is possibly risky as well since you do not know how long it will take to work or if it will work at all or if you will experience side effects. You can contact me if you want to discuss what I did. Amanda

I have moderate asthma, and use a preventing treatment which includes not only Albuterol inhaler, but also low steroids inhaler. I am pregnant with #2 now. In both my first pregnancy and now, I used those inhalers. The doctors (regular, Ob as well as specialist lungs dr) said it is important to continue to take the treatment and if needed to increase the dosage. This is because it is very important to keep the level of oxygen in the blood. Lower level of Oxygen can be dangerous! The level of oxygen drops in severe asthma attacks so the most important thing is not to reach a severe attack, and keep your condition in balance. Our babies influenced from what we eat and what medications we take, as well as from our genes. But low level of Oxygen can be much more dangerous to his life than a minor dosage of preventing treatment. So, of course you can try to rest and don\x92t do any activities that make difficulties in breathing, and try other possibilities to improve your condition (and you should be prepared that it is going to be worse during the pregnancy). However, don\x92t neglect the problem. A

Dear Wheezy, I checked with both my allergist (Jim Nickelsen, pediatric asthma specialist) and my OB when I was pregnant and handling my asthma. Both were adamant that I keep up with my Albuterol as needed. They both said the same thing, basically, that decreased oxygen flow to the placenta was a much greater risk to the baby than albuterol crossing the placenta. I think I also remember reading that the actual blood levels of albuterol are very small if you are using an inhaler. My baby came out fine, and at 19 months, she hasn't shown any signs of asthma either!

ps. I still use the albuterol and I am nursing. denise.

I did not see your original posting but had problems with asthma during both of my pregnancies. My second child is now 3 months old, and I'm still using the inhalers I started during this pregnancy. I don't normally have asthma problems but tend to get it when I have a cold or other type of virus. Sometime towards the end of my second trimester with this most recent pregnancy I found myself very short of breath and it was keeping me awake at night. At first, I just thought it was from my lungs being compressed but when I was sent to Alta Bates to get it checked my oxygen saturation levels were on the low side. The OB on-call put on albuterol and serevent, which made my heart race frequently. I saw a pulmonologist very shortly after who took me off the serevent and gave me beclemethasone which she felt was one of the safest cortico-steroids to use in pregnancy since it has been around for a long time with no known adverse effects. Once this medicine started working for me, I didn't even need any more albuterol.

During my first pregnancy, the asthma was not diagnosed and I ended up developing a very severe bronchitis about two weeks before my due date. One of the benefits of having caught the asthma early on this time around was that I was able to avoid getting bronchitis again, even though I got a bad chest cold at the end. Anyway, of most relevance here is that I was told by every practitioner I saw during this last pregnancy that it is very important to stay on the medicine and to get checked out immediately if you are having any problems breathing because the loss of oxygen can happen very quickly, which can endanger your baby. It is very scary to have to take medicine when you are pregnant, but sometimes it really is to your baby's benefit. Good luck! Hannah

Doctor advising steriods for asthma

December 2003

I am 4 weeks pregnant and allergies have been triggering my asthma badly for the last two weeks. My doctor is encouraging me to use steroids in spray (Qvar) and allergy medicine (Claritin). A nurse practitioner at Kaiser told me that they are safe to use during pregnancy but I am still scare to use them. I use a bronchodilator (albuterol) , and I have an air cleaner and a humidifier in our room but its not enough to keep me well long term. I am starting to worry because I don\x92t know if I am getting the enough oxygen the embryo needs. Does anybody knows of and alternative treatment or Dr. for this or has anybody used steroids and allergy medicine during pregnancy. Thanks in advance fro your help JI

I had quite a bit of allergy trouble, and I used Zantac during pregnancy, as well as Sudafed. Both are considered ''safe.'' I would have preferred to take nothing, but I absolutely could not breathe or sleep (I kept having dreams of suffocation from the congestion). I researched Sudafed during pregnancy online, and found that the effect on the fetus (after trimester 1) is slight hyperactivity -- you may want to read about it and see whether you're comfortable with it.

The medications helped tremendously, and the baby suffered no ill effects. What actually convinced me to take the medicine was the nurse practitioner telling me that my being unable to breathe was not a healthy state of affairs, and that if she were in my shoes, she would take the medication (in fact, she did when she was pregnant!)

Good luck. been there

- I took QVAR and albuterol during my recent pregnancy. I wasn't comfortable with it either, but did a lot of research and found that the danger of the baby getting too little oxygen is much higher than the tiny amount of the drug they receive. (Inhaled asthma drugs do not readily enter the bloodstream.) QVAR is definitely the best steroid to take - I switched to it because it's been around the longest and has a very good safety record.

It turns out I didn't have to use drugs very much because my asthma got much better from the pregnancy hormones that relax smooth muscles. Now that I've delivered, the asthma is back in full force, but it was very mild during the last 5-6 months of pregnancy. Maybe this will happen to you!

For alternative treatment, you might want to look into acupunture and herbs with Marti Kennedy in Berkeley, who specializes in prenatal care (don't have her number handy, but she's in the phone book). I saw her late in pregnancy for other reasons and she said she would have been able to help with the asthma had I come to her earlier. --Another Wheezer

Hi, I had a healthy boy, and used asthma meds all through my pregnancy. I was on Singulair, Pulmicort, and Albuterol. My Dr. also said Claritin was ok. He preferred Pulmicort over Flovent because Pulmicort has been out longer-- thus more proof it was ok for babies. The asthma meds helped me immensly, the Dr. assured me it was more important for me to breathe than any minimal risks the meds might carry. His name is Dr David Denmead,(925 463 9400 I think) he's an allergy/asthma specialist who has offices in pleasanton and I think danville. He's worth the drive if he covers your insurance. I went to my reg dr. for the first 3 mos of my pregnancy and my asthma just got worse and worse. Dr. Denmead had me breathing easy within a week after my appt, and he's extremely knowledgeable about asthma/allergy meds and pregnancy. Good luck and remember, a healthy mom means a healthy baby! Rebecca

I know the suggested drugs concern you, but I would really worry about your baby's development without sufficient oxygen.

Go back to your doctor. Wheezing is absolutely unacceptable in pregnancy, but steroidal sprays and very new antihistamines are negotiable. As alternatives to the steroidal spray, some folks get relief with Cromolyn (Intal) or nedocromil (Tilade). (They didn't do a thing for me.) Claritin is new enough that I'd be cautious about it, but there are lots of older antihistamines on the market--ask your doctor about them. But definitely do something to stop the wheezing, even if it means a few weeks of a steroidal spray. And don't hesitate to use Albuterol when you need it--but recognize that it's a *rescue* asthma treatment, not a maintenance treatment.

Perhaps you normally have very mild asthma and have not had to use these sorts of meds before. Did you know that with pregnancy, about 1/3 of asthmatic women get worse, 1/3 get better, and 1/3 stay the same? Maybe you're in the first group. I'm sorry! I hope you get relief soon. Jennie

QVAR is very safe during pregnancy (I took it myself during both my pregnancies, and as a pediatrician, I've taken care of several patients whose mothers also took it or other inhaled steroids during pregnancy). Sometimes asthma does get worse during pregnancy -- it's better to control it well with inhaled steroids than to worry about having to use oral steroids if things get worse (but, even then, a brief course of oral steroids is better than worrying about not getting enough oxygen to your placenta, etc). anon

I also am pregnant (22 weeks) and have asthma. My FANTASTIC allergy/asthma specialist (Dr. James Nickelson, on Telegraph in Berkeley) told me that Pulmicort (Budesonide) is the only (or one of the only?) Class A medication for asthma--it's a controller, not a quick relief (like albuterol). I highly recommend you see him. He knows his stuff. Good Luck! robin

I took Claritin while pregnant and didn't have any problems. My doctor thought that it was better to deal with the allergies. Claritin has been an over-the-counter medicine in Canada for years - much longer than in the US. And I haven't seen any warnings for pregnant women there. Anon

I used albuterol and inhaled steroids throughout all three of my pregnancies. I am blessed with three healthy children.

Not only are the inhaled drugs ''safe'' to use (inhaled drugs are best because they go directly to the lungs without first going through the bloodstream/crossing the placenta) but the worst POSSIBLE thing you can do to your baby is to risk not controlling asthma while pregnant. Do what your doctor tells you, and if you don't trust your doctor, find one you do! If a variety of antihistimines work for you, pick the ''safest'' but don't try to do without if you have allergy triggered asthma.

An interesting aside about albuterol is that it is a smooth muscle relaxant --- and years ago was routinely prescribed to help stop early OB warned me that my 2nd child might be late because of albuterol use (he was 3 wks early, instead).

My understanding of breathing and pregnancy is that, (unlike fetal nutritional needs where the baby gets fed first and your body gets what's left...) your baby can ONLY receive enough oxygen for healthy growth if you are getting enough yourself. Don't take chances, please.

Please do whatever research, and visit whatever doctors you need to establish a regime that you're comfortable with, and that assures you of a safe, asthma free pregnancy. An internet search will turn up lists of ''safe'' allergy and cold drugs. Good luck! Heather