Q. What can I do to manage my asthma while I am pregnant?

A. Pregnancy does affect a woman's asthma, with one-third reporting their asthma gets worse, one-third noting it gets better and one-third saying it stays the same. That means women with asthma often need to continue using medications while pregnant.

Although most women are hesitant to take medications while pregnant, it is important to keep in mind that poorly controlled asthma can be harmful to your baby, while most asthma medications are not. That's because any decrease in oxygen levels can affect the amount of oxygen your baby receives, possibly causing problems.

The goal for pregnant women, as for any patient, is to control asthma symptoms with the least amount of medication possible. This may mean taking daily inhaled corticosteroids or oral medications, or it could mean taking allergy medications (steroid nasal sprays and antihistamines) to reduce allergy/asthma triggers.

Several medications appear safe for pregnant women, although we generally try to avoid oral medications during the first trimester if possible.

Additionally, it is important to be evaluated by an asthma specialist, as well as your obstetrician, throughout your pregnancy. Have a breathing test called spirometry regularly to ensure your air passages are working well.

Q. How should I treat exercise-induced asthma?

A. Exercise-induced asthma affects up to 20 percent of competitive athletes and 90 percent of people with asthma. Left untreated, it could result in death.

Symptoms include:
• Difficulty breathing six to eight minutes after you stop exercising.
• Coughing or wheezing when exercising.
• Feeling tightness in your chest.
• Feeling extremely tired or short of breath after exercising.

For mild exercise-induced asthma, you can take two or three puffs of a bronchodilator like albuterol or pirbuterol about 15 to 20 minutes prior to exercise. If that doesn't control your exercise-induced asthma, you may need preventative medications such as inhaled corticosteroids. A breathing test can help determine the need for preventative medications.

Also avoid exercising outside in very cold weather, very hot weather, or when the air quality is poor, all of which can make your symptoms worse. If you can't tolerate strenuous running sports, consider exercise such as walking, light jogging and leisure biking. Also, warming up before you start working out can alleviate chest tightness, while breathing through pursed lips may help reduce airway obstruction.

-- Marianne Frieri, MD, PhD
Director of Allergy/Immunology
Nassau University Medical Center
East Meadow, NY

-- Shelly M. Harvey, MD
Clinical Instructor
University of Texas Southern Medical Center
Pediatric Allergy/Immunology Associates
Dallas, TX