Asthma's Algorithms

Managing asthma during pregnancy finds new direction in MAP study

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Of course, one of the goals in pregnancy is to avoid or lessen in utero exposure to drugs. Maternal asthma is a tough condition to control while minimizing medicines.

A recent study called managing asthma during pregnancy (MAP) finds that asthma in a pregnant woman may be managed better when doctors assess the actual measures of airway inflammation instead of self-reported symptoms. The researchers used an improved version of the measurement of fraction of exhaled nitric oxide (FENO) to attain the actual level of inflammation in the woman's airway.

"Ask your doctor if FENO is available to manage asthma symptoms."

Stanley J Szefler, M.D., Department of Pediatrics, National Jewish Health, and University of Colorado School of Medicine, Denver, CO, comments that these study results support the hypothesis that FENO-guided therapy for asthma in pregnancy could possibly lead to better fetal outcomes, but further study is needed to support this notion. He recommends future research should be aimed at applying the algorithm approach to routine prenatal care.

MAP included 220 pregnant, non-smoking women managing asthma. They were randomly assigned to one of two groups. The first group of women had their treatment adjusted monthly by assessing their clinical symptoms, while the second group had their asthma managed based on FENO concentrations gathered monthly. The rate of asthma attacks in the FENO concentration group was approximately half of that in the control group. (.29 vs. .62 asthma attacks per pregnancy).

The authors report that the reduction in asthma attacks was accompanied by important adjustments in asthma maintenance, including more frequent use of inhaled corticosteroids (Flovent, Asmanex) but at a lower daily dose. An earlier introduction of long-acting B2 agonists was also indicated in the patients using the improved FENO asthma management recommendations. The FENO system made custom tailoring a woman's asthma drug needs more definitive because symptom-based treatment decisions may over- or under-medicate pregnant women.

The authors conclude that the use of symptoms + FENO measurement improved the treatment decisions for pregnant women with asthma. Hopefully, the researchers report, these results can be useful in managing asthma in all people.

Reviewed by: 
Review Date: 
September 7, 2011
Last Updated:
September 12, 2011