Inhaled corticosteroids called top Tx option in pregnancy; moderate, persistent asthma.(Obstetrics)

TORONTO -- Inhaled corticosteroids such as budesonide and beclomethasone are the best bet for treating moderate, persistent asthma in pregnant women, according to Dr. Scott Osur.

Studies have indicated that inhaled corticosteroids are rarely associated with congenital malformations. "Inhaled corticosteroids are extremely safe during pregnancy. This is a very important take-home message," Dr Osur said at an international conference on allergy and clinical immunology sponsored by the State University of New York at Buffalo.

Of the inhaled corticosteroids, budesonide appears to be the best choice. It is the only inhaled corticosteroid that is category B. "About a year and a half ago, the FDA changed the product labeling for budesonide from category C to B," said Dr. Osur of Albany (N.Y.) Medical Center. This change was based largely on the findings of a 1999 study of 2,014 records in the Swedish Medical Birth Registry, which showed no increased risk for congenital malformations, premature birth, low birth weight, C-section, stillbirth, or multiple births associated with the use of budesonide during pregnancy (Obstet. Gynecol. 93[3]:392-95, 1999).

Budesonide is an especially good choice for pregnant women who require high doses of inhaled steroids because it maximizes adherence, minimizes the need for systemic steroids, and has limited systemic effects.

"There's really little evidence that if you have well-controlled asthma in pregnancy you will have any increase in maternal or fetal complications," said Dr. Osur.

He noted that, in addition to inhaled corticosteroids, there are several other medications that are safe and effective for treating pregnant asthmatics:

* Short-acting [beta]-agonists. Terbutaline has a slight edge given its category B classification, although it's hard to find. Albuterol or metaproterenol are safe alternatives given how long these drugs have been available.