Drug Topics - May 12, 2008 - (Page 22)

22 DRUG TOPICS MAY 12, 2008 www.drugtopics.com Rx Care Treating asthma during pregnancy safer than not, says new guide Heidi Belden, Pharm.D. A bout 4% to 8% of pregnancies will be complicated by asthma, a potentially serious condition that can lead to significant morbidity. Up until now, pharmacists and other practitioners have not had a guide to aid in choosing appropriate medical treatment. Recently, however, the American College of Obstetricians and Gynecologists (ACOG) released a practice bulletin for the management of asthma during pregnancy. According to the ACOG committee responsible for developing the guide, the prevalence of asthma during pregnancy and the morbidity associated with it are on the rise, despite the fact that overall asthma mortality rates have declined in recent years. “Poorly controlled asthma in a pregnant woman has unique adverse consequences,” Leslie Hendeles, Pharm.D., told Drug Topics. “Asthma attacks may deprive the fetus of oxygen and have been linked to increased prematurity, growth restriction, and other fetal complications.” Hendeles, who is a professor of both pharmacy and pediatrics at the University of Florida Colleges of Pharmacy and Medicine, added that asthma leads to increased morbidity and mortality in the mother as well. According to the ACOG recommendations, it is safer for pregnant women with asthma to be treated with medications than to experience asthma symptoms and exacerbations, and that the main goal of asthma treatment is to maintain sufficient oxygenation of the fetus by preventing hypoxic episodes in the mother. In addition, a step-care therapeutic approach that entails increasing both the number and dosage of medications as asthma severity increases should be utilized by practitioners treating this population. For mild intermittent asthma, the panel recommends albuterol as needed with no regular daily medications. For mild persistent disease, the preferred regimen is a low-dose inhaled corticosteroid (ICS). Cromolyn, a leukotriene receptor antagonist, or theophylline may be given as alternatives. Budesonide is considered the preferred inhaled corticosteroid. “There are substantial data on the safety of budesonide during pregnancy from large epidemiology studies in Sweden,” Hendeles said. He also pointed out that budesonide is considered a Category B drug, whereas the other ICSs are labeled as Category C. For pregnant women with moderate persistent asthma, the recommended treatment is a low-dose ICS and salmeterol or a medium-dose ICS and salmeterol if needed. An alternative regimen would be a low- or medium-dose ICS with either a leukotriene receptor antagonist or theophylline to a target serum level of 5 to 12 mcg/ml. Severe persistent asthma requires a high dose of ICS and salmeterol, plus an oral corticosteroid if needed. An alternative regimen includes theophylline in place of the salmeterol. The recommended rescue therapy for all levels of asthma severity is inhaled albuterol. The new ACOG guidelines also emphasize that avoiding exposure to tobacco smoke and other allergens and irritants can improve maternal well-being and reduce the need for medication. Immunotherapy is recommended for women who are at or near a maintenance dose, who have not had adverse reactions to the injections, and are receiving a clinical benefit. However, women should not begin allergy shots during pregnancy. This is due to the potential for the escalating doses of immunotherapy to cause anaphylaxis during pregnancy, which has been associated with maternal and fetal death. For women with asthma who are breast-feeding, use of prednisone, theophylline, antihistamines, ICS, beta-2-agonists, or cromolyn is not contraindicated. The guide asserts that optimal management of asthma in order to maintain normal pulmonary function during pregnancy includes objective monitoring of lung function, avoiding or controlling asthma triggers, individualizing pharmacotherapy, and patient education. Practice Bulletin #90 “Asthma in Pregnancy” was developed based on a review of the best available evidence regarding the management of asthma during pregnancy and was published in the February 2008 issue of Obstetrics & Gynecology. Photo: Jim Shive http://www.drugtopics.com

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Drug Topics - May 12, 2008 Contents Latebreakers Letters R.Ph.s Say More Needs to be Done to Prevent Pediatric Drug Errors There's a New School of Thought on Use of Beta-Blockers for Hypertension Cover Story Guest Spot Letters Clinical Practice Special Report Professional Practice Broad Label for New Leukemia Therapy Looks Promising Treating Asthma During Pregnancy Safer than Not, Says New Guide In the Pipeline Clinical Q&A APhA Leader's Plan to Leave Office Takes Center Stage at its Conference Policies Passed at a Glance Giving a Talk to the Community? Check Out These Materials This Foundation has Funds to Spare JP at Large Cover Story: Employers and R.Ph.S: A Win-Win Combo FDA's Ilisa Bernstein Discusses Pharmacy Affairs Legal Q&A Manufacturers Unleash a Rash of Poison Ivy Treatments Are OTC Cold Remedies Safe for Kids? Probiotics are All the Rage: How You Can Capitalize on It CMS' Prices for Round One of DMEPOS Competitive Bidding Raising Concerns CVS Caremark's Mentoring Program Recruits and Retains R.Ph.s Antibiotic Resistance Among Community Pathogens Technology Update New Products Advertisers Index Classified Viewpoint

Drug Topics - May 12, 2008

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