Management Program Key to Asthma Control During Pregnancy.

RENO, NEV. - Instituting a comprehensive asthma management program may be more important than the choice of which drug to use during pregnancy, Dr. Mitchell Dombrowski said at the annual meeting of the Society for Maternal-Fetal Medicine.

This observation represents a shift in thinking that has occurred in recent years. "If you had asked me 5 years ago what was the most significant aspect of the management of asthma in pregnancy, I would have said using beclomethasone," said Dr. Dombrowski, professor of obstetrics and gynecology at Wayne State University, Detroit.

Increased understanding of the inflammatory component of asthma has prompted the adoption of inhaled corticosteroids as the treatment of choice for the prevention of disease exacerbation. But theophylline, which is used much less frequently today than in the past, also has a number of anti-inflammatory effects.

"For example, theophylline decreases leukotriene production and histamine release from mast cells," he explained. "It's not just a bronchodilator."

And the results of a randomized trial of inhaled beclomethasone compared with oral theophylline found similar rates of asthma exacerbation during pregnancy with the two drugs. This suggests that patients on theophylline need not be switched to an inhaled steroid during pregnancy if they are not troubled by jitteriness or other side effects seen with theophylline, Dr. Dombrowski said at the meeting.

The double-blind, double-placebo-controlled study included a total of 398 women from 13 centers who had moderate asthma.

Study participants were given inhaled beclomethasone, four puffs three times daily, or oral theophylline titrated to a target serum level of 8-12 [micro]g/mL.