Asthma treatment in pregnancy: A randomized controlled study

OBJECTIVE: Our purpose was to study the effect of inhaled corticosteroids on asthma exacerbations in pregnancy. STUDY DESIGN: We prospectively studied 84 pregnant women with 105 asthma exacerbations. Women were hospitalized if the forced expiratory volume in 1 second was <70% after sequential bronchodilator therapy. They were randomly assigned to receive either intravenous aminophylline and inhaled beta(2)-adrenergic receptor agonist or intravenous methylprednisolone and a beta(2)-adrenergic receptor agonist. At discharge women were randomly assigned to receive either inhaled beclomethasone, beta(2)-adrenergic receptor agonist, and an oral corticosteroid taper or a beta(2)-adrenergic receptor agonist and a corticosteroid taper. RESULTS: Sixty-five (62%) of 105 women with exacerbation required hospitalization. Aminophylline did not shorten response time or decrease hospital stay. Readmission rate was decreased by 55% in women given inhaled beclomethasone (33% vs 12%, p < 0.05, odds ratio 3.63, 95% confidence interval 1.01 to 13.08). Pregnancy-induced hypertension and cesarean delivery were increased over those of the general population. CONCLUSIONS: Intravenous aminophylline offers no therapeutic advantages. Continuous inhaled corticosteroids reduced the need for subsequent admissions.