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Tuesday, January 8, 2013

Nitric Oxide may help pregnant women manage asthma

Asthma is among the most prevalent chronic conditions that afflict pregnant women.  Fear about the effects of asthma medicine on the unborn babies makes treating asthma in pregnancy a major challenge.  Yet a recent study shows nitric oxide might help doctors manage asthma in pregnant women.

According to about eight percent of women experience asthma during pregnancy.  Studies show that during the first six months of gestation asthma symptoms increase, and symptoms decrease during the final months of pregnancy.

Studies also show hospitalizations due to asthma increase during pregnancy, and other studies show a link between worsening asthma and decreased fetal growth.  Studies also link asthma in pregnancy with high blood pressure, preterm delivery, and all sorts of other complications.

These studies shed light on the need of finding a method to help these women better manage their asthma. Asthma experts in Australia believe they've found the solution. reports on a program being trialed in Australia to help control and prevent asthma among pregnant women that has been rather successful.  The program is based on an algorithm that helps asthma doctors titrate asthma medicine to manage inflammation in the air passages.

The program was sparked by a study published in the Lancet that showed that asthma exacerbations in pregnant women could be "halved" if inflammation was "closely monitored."  Yet due to fears of women and doctors about the effects of asthma medicine on the unborn baby, many cases of asthma among pregnant women go untreated.

However, as I wrote in this post, most asthma experts believe that it's important to control asthma in pregnant women, and the advantages of taking asthma medicine should be based on weighing the advantages against the disadvantages.

Inhaled steroids are a proven and effective way of treating the chronic inflammation in asthmatic lungs.  When it comes to pregnant women, you want to have the least amount of the medicine needed to control inflammation.  Yet you don't want too little inhaled steroid in your system because then the medicine won't be doing the job.

So Australian experts came up with a Managing Asthma in Pregnancy (MAP) study whereby they monitor inflammation in the lungs by measuring the Fraction of Exhaled Nitric Oxide (FENO).  This is a test that is growing in acceptance because it directly measures how much inflammation is in the lungs.

Based on the FENO results, an algorithm is used to help doctors determine the best dose of inhaled steroid to use.

The study consisted of 220 pregnant women, half had their inhaled steroid adjusted using the algorithm and clinical symptoms, and the other half had their inhaled steroids adjusted using clinical symptoms alone.  The results concluded that those who used the both the algorithm and clinical symptoms to titrate their inhaled steroid were 50 percent less likely to have an asthma flare up.

Researchers surmised the women who used the algorithm to control their asthma used their inhaled steroid more often, although at a lower dose.  This group was also introduced to long-acting asthma preventative medicine sooner than the other group.  Their inflammation was therefore better controlled.

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