Medically Reviewed On: July 01, 2008

ANNOUNCER: Doctors say its extremely important for women with asthma to treat their disease especially when pregnant.

EMILY DIMANGO, MD: The risks to the mother of not treating asthma have been well-documented. And those risks are serious. They can cause medical problems among the mother and medical problems among the baby.

ANNOUNCER: There are two major categories of asthma, each requiring different treatment strategies. Intermittent asthma requires treatment only during flare-ups. Persistent asthma needs chronic medication.

EMILY DIMANGO, MD: People who have asthma symptoms are indicating that there's untreated airway inflammation, and that brings us to the class of inhaled corticosteroids. Those drugs combat the inflammation, and it is the inflammation that causes asthma.

RUSSELL SETTIPANE, MD: It is those patients who have persistent asthma who need to be on chronic controller medications. The persistent asthma is the asthma where these symptoms are occurring more than twice a week: symptoms such as shortness of breath, coughing and wheezing occurring more than twice a week. Or if those symptoms are severe to wake the patient from sleep more than twice a month. That is persistent asthma and we need to use controller medications.

ANNOUNCER: What about safety? Women who are pregnant have a special reason for concern, because some medications can harm a fetus.

MICHAEL SCHATZ, MD: Probably the most important aspect of treating asthma in pregnancy and certainly in working with the patient is trying to balance the risk of not treating against the risk of treating.

ANNOUNCER: Doctors say they feel very comfortable prescribing inhaled medications to counter occasional asthma attacks. The quick-relief drugs, often called "rescue" medicines, have been used for twenty years. And research supports the widespread view that they are safe.

MICHAEL SCHATZ, MD: In the rescue therapy category are the beta agonists -- the inhaled beta agonists such as albuterol -- which do relieve symptoms quickly and people feel comfortable using during pregnancy based on the fact that they've been around a while and there is some human data that's reported. In general, we always feel more comfortable with inhaled medicines during pregnancy versus oral medicines, because less is likely to get to the baby.

ANNOUNCER: Safety issues are especially important with medicines used for the more chronic control of asthma, because the fetus is potentially exposed to those drugs for a longer time.

ALLAN STILLERMAN, MD: The FDA, the Food & Drug Administration categorizes drugs according to their level of risk. Firstly, controlled animal data is reviewed and if available, human data as well as to how these drugs impact on the developing fetus, particularly when taken in the first trimester of pregnancy when the risk for fetal malformations is greatest.

RUSSELL SETTIPANE, MD: The best -- highest category is a category A. Most medications for asthma have been rated category C. There are no category A medications for asthma in pregnancy; the highest rated medications we have are category B.

ANNOUNCER: Among the drugs used to control persistent asthma, the FDA has recently upgraded the safety designation for one of the newer options.

EMILY DIMANGO, MD: Drugs used to combat inflammation, namely inhaled corticosteroids have traditionally been classified as category C. However, recently enough data has been generated to show that inhaled budesonide or Pulmicort may be categorized as B category, meaning that it is safe for babies born to mothers who are taking that drug during pregnancy.

MICHAEL SCHATZ, MD: So in the case of budesonide, this came from the Swedish medical birth registry, where all of the births in Sweden are monitored and registered. And the group of patients -- which numbered over 2500 who took budesonide -- were compared to the hundreds of thousands of women who didn't take budesonide. And they were able to show in that very large number of patients that there were no increased risks in the infants of the mothers taking budesonide.

ANNOUNCER: Doctors say other inhaled corticosteroids, including beclomethasone, triamcinolone, and fluticasone, may prove just as safe, but there are too little data right now to be sure.

There are two non-steroidal anti-inflammatory medications that are category B drugs. But they are generally not considered as effective as inhaled steroids in treating women with asthma.

Safety categorization is just one factor in selecting a therapy. A panel of asthma experts recommended that women should stay on some category C drugs when they become pregnant, if the drug proved effective before the pregnancy began.

Doctors say anyone with persistent asthma should be taking medication. And that includes women, even if they're pregnant. But with a wide range of medication to choose from, doctors say women who are treating their disease should feel confident their unborn child is receiving the best possible care.

EMILY DIMANGO, MD: The good news is that even though poorly controlled asthma can be dangerous to the pregnant mother and to her baby, asthma is relatively easy to control and the drugs that are available to treat asthma have now been shown to be safe for mother and for baby.