A 23-year-old G1P0woman at 10 weeks' gestation presents to the obstetrics clinic for her initial evaluation. She says she has been hospitalized several times for asthma exacerbations but has never required intubation or admission to an intensive care unit. She is controlled on daily inhaled corticosteroids and albuterol with adequate relief of her symptoms. She is concerned about taking these medications now that she is pregnant.Which of the following is true regarding asthma medications in pregnancy:
Asthma in Pregnancy – Important Points:

Asthma is the most common chronic condition in pregnancy and affects 3–12% of gestations.
Effects of pregnancy on asthma: The course of the disease is very much unpredictable. In about 20%, the condition improves, in 30%, it deteriorates and in 50%, it remains unchanged.
It is more likely to deteriorate in women with severe asthma.
Exacerbations are most frequent between 24 to 36 weeks gestation and are most commonly precipitated by viral respiratory infections and non compliance with inhaled corticosteroid regimens.
Because asthma exacerbation can be severe, they should be treated aggressively in pregnancy.
Effects of asthma on pregnancy: Preterm labor PROM, preeclampsia, LBW baby and slight increase in abruptio placenta.
Severity of asthma correlates with FEV1 and PEFR (peak expiratory flow rate) FEV1 ideally is > 80% of the predicted value and PEFR FEV1 less than 1L or less than 20% of predicted value, correlates with severe disease.

Management of Asthma in Pregnancy:

Mild asthma: Inhaled beta agonist (albuterol preferred because of more human data on safety in pregnancy).
Mild persistent: Low dose inhaled corticosteroids (Budesonide preferred).
Moderate: Low dose inhaled corticosteroids and long acting b agonist (Salmetrol preferred).
Severe: High dose inhaled corticosteroid and long acting beta agonist and oral steroids if needed.


PGF-2 alpha is absolutely C/I in patients of Asthma
So, if in an asthmatic patient PPH occurs drug of choice is PGE1
In asthmatic patients DOC for cervical ripening-PGE2 (PGE2 is not contraindicated in asthmatics).
B2 agonist are contraindicated during pregnancy.
Both B2 agonist and inhaled corticosteroids are both contraindicated in pregnancy.
Both B2 agonist and inhaled corticosteroids are safe in pregnancy
B2 agonist and inhaled corticosteroids are both safe in pregnancy but during 2nd and 3rd trimester only