Ali Z, Hansen AV, Ulrik CS. Exacerbations of asthma during pregnancy: Impact on pregnancy complications and outcome. J Obstet Gynaecol.. 2016; 36:(4)455-61

Asthma UK. Your Asthma Action Plan. 2016. (accessed 12 April 2018)

Asthma UK. Asthma facts and statistics. 2018a. (accessed 12 April 2018)

Asthma UK. Data Portal. Asthma data visualisations. 2018b. (accessed 12 April 2018)

Bain E, Pierides KL, Clifton VL Interventions for managing asthma in pregnancy. Cochrane Database Syst Rev.. 2014; (10)

Blackburn HK, Allington DR, Procacci KA, Rivey MP. Asthma in pregnancy. World J Pharmacol.. 2014; 3:(4)56-71

Borish L. The immunology of asthma: asthma phenotypes and their implications for personalized treatment. Ann Allergy Asthma Immunol.. 2016; 117:(2)108-14

Braido F. Failure in Asthma control: reasons and consequences. Scientifica (Cairo). 2013; 2013

Breton MC, Beauchesne MF, Lemière C, Rey É, Forget A, Blais L. Risk of perinatal mortality associated with inhaled corticosteroid use for the treatment of asthma during pregnancy. J Allergy Clin Immunol.. 2010; 126:(4)772-7

British Lung Foundation. Asthma Statistics. 2018. (accessed 12 April 2018)

British Thoracic Society, Scottish Intercollegiate Guidelines Network. British Guideline for the management of asthma. 2016. (accessed 12 April 2018)

Chamberlain C, Williamson GR, Knight B, Daly M, Halpin DM. Investigating women's experiences of asthma care in pregnancy: A qualitative study. Open Nurs J.. 2014; 8:56-63

Eltonsy S, Blais L. Asthma during pregnancy and congenital malformations: The challenging task of separating the medication effect from asthma itself. J Allergy Clin Immunol.. 2016; 137:(5)1623-4

Enriquez R, Wu P, Griffin MR Cessation of asthma medication in early pregnancy. Am J Obstet Gynecol.. 2006; 195:(1)149-53

Global Initiative for Asthma. 2018 GINA Report, Global Strategy for Asthma Management and Prevention. 2018. (accessed 12 April 2018)

Goldie MH, Brightling CE. Asthma in pregnancy. The Obstetrician and Gynaecologist. 2013; 15:241-5

Grzeskowiak L, Smithers L, Grieger J Asthma treatment impacts time to pregnancy: evidence from the international SCOPE study. Eur Respir J.. 2018; 51:(2)

Hedgewald MJ, Crapo RO. Respiratory Physiology in Pregnancy. Clin Chest Med.. 2011; 32:(1)1-13

Hodder R, Lougheed DM, Rowe BH Management of acute asthma in adults in the emergency department: nonventilatory management. CMAJ. 2010; 182:(2)E55-67

Hughes M, Savage E, Andrews T. Accommodating interruptions: A grounded theory of young people with asthma. J Clin Nurs.. 2018; 27:(1-2)212-22

Hviid A, Mølgaard-Nielsen D. Corticosteroid use during pregnancy and risk of orofacial clefts. CMAJ. 2011; 183:(7)796-804

Jackson DK, Sykes A., Malia P, Johnstone SL. Asthma exacerbations: origin, effect, and prevention. J Allergy Clin Immunol.. 2011; 128:(6)1165-74

Knight K, Nelson-Piercy C. Chapter 5. Lessons for the care of women with medical and general surgical disorders. In: Knight M, Nair M, Tuffnell D (eds). Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2017

Lindquist A, Knight M, Kurinczuk JJ. Variation in severe maternal morbidity according to socioeconomic position: a UK national case–control study. BMJ Open. 2013; 3:(6)

LoMauro A, Aliverti A. Respiratory physiology of pregnancy: Physiology masterclass. Breathe (Sheff). 2015; 11:(4)297-301

McCallister JW. Asthma in pregnancy: management strategies. Curr Opin Pulm Med.. 2013; 19:(1)13-7

McCallister JW, Cathy G, Benninger HA. Pregnancy related treatment disparities of acute asthma exacerbations in the emergency department. Respir Med.. 2011; 105:(10)1434-40

McCormack MC, Wise RA. Respiratory Physiology in Pregnancy. In: Rosene-Montella K, Bourjeily G (eds). New York, NY: Humana Press; 2009

McLaughlin K, Kable A, Ebert L, Murphy V. Barriers preventing Australian midwives from providing antenatal asthma management. British Journal of Midwifery. 2015; 23:32-39

McLaughlin K, Foureur M, Jensen ME, Murphy VE. Review and appraisal of guidelines for the management of asthma during pregnancy. Women Birth. 2018;

Mehta N, Chen K, Hardy E, Powrie R. Respiratory disease in pregnancy. Best Pract Res Clin Obstet Gynaecol.. 2015; 29:(5)598-611

Milhaltan FD, Antoniu SA, Ulmeanu R. Asthma and pregnancy: therapeutic challenges. Arch Gynecol Obstet.. 2014; 290:(4)621-7

Murphy VE. Managing asthma in pregnancy. Breathe (Sheff). 2015; 11:(4)258-67

Murphy VE, Namazy JA, Powell H, Schatz M A meta-analysis of adverse perinatal outcomes in women with asthma. BJOG. 2011; 118:(11)1314-23

Nair M, Kurinczuk JJ, Knight M. Establishing a national maternal morbidity outcome indicator in England: A population-based study using routine hospital data. PLoS One. 2016; 11:(4)

Namazy JA, Chambers C, Schatz M. Safety of therapeutic options for treating asthma in pregnancy. Expert Opin Drug Saf.. 2014; 13:(12)1613-21

NHS England. The never events list; 2013/14 update. 2013. (accessed 13 April 2018)

National Institute for Health and Care Excellence. Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors [GC110]. 2010. (accessed 13 April 2018)

Nolte AGW, Hastings-Tolsma M, Hoyte F. Midwifery management of asthma and allergies during pregnancy, birth, and the postpartum. British Journal of Midwifery. 2015; 23

Standards for Medicines Management.London: NMC; 2007

The Code: Professional standards of practice and behaviour for nurses and midwives.London: NMC; 2015

Pali-Schöll I., Namazy J, Jensen-Jarolim E. Allergic diseases and asthma in pregnancy, a secondary publication. World Allergy Organization Journal. 2017; 10:(1)

Powell C, Kerry D, Milan SJ Inhaled magnesium sulfate in the treatment of acute asthma. Cochrane Database Syst Rev.. 2012; 12

Royal College of Physicians. Why asthma still kills: The National Review of Asthma Deaths (NRAD). 2014. (accessed 13 April 2018)

Schatz M, Dombrowski MP. Asthma in pregnancy. N Engl J Med.. 2009; 360:(18)1862-9

Schatz M, Dombrowski MP, Wise R The relationship of asthma medication use to perinatal outcomes. J Allergy Clin Immunol.. 2004; 113:(6)1040-5

Skuladottir H, Wilcox AJ, Ma C Corticosteroid use and risk of orofacial clefts. Birth Defects Res A Clin Mol Teratol.. 2014; 100:(6)499-506

Tamási L, Horváth I, Bohács A, Müller V, Losonczy G, Schatz M. Asthma in pregnancy–Immunological changes and clinical management. Respir Med.. 2011; 105:(2)159-64

Vanders RL, Murphy VE. Maternal complications and the management of asthma in pregnancy. Womens Health (Lond). 2015; 11:(2)183-91

Vasilakis-Scaramozza C, Aschengrau A, Cabral HJ, Jick SS. Asthma drugs and the risk of congenital anomalies. Pharmacotherapy. 2013; 33:(4)363-8

Asthma in pregnancy: Physiology, management and recommendations for midwives

02 July 2018
7 min read
Volume 26 · Issue 7


Asthma in pregnancy is a common respiratory co-morbidity, but if this serious condition is not addressed appropriately, acute exacerbations may contribute to maternal mortality and morbidity. Indeed, any acute episode of asthma can quickly become life-threatening, and midwives should be aware of the need for urgent referral. The importance of effectively managing asthma in pregnancy includes the immediate detection of a worsening condition, along with immediate referral to a physician in order to minimise the complications associated with acute exacerbations. In order to minimise poor outcomes for women, midwives should be aware of evidence-based practice guidelines for managing asthma and to avoid complacency, midwives must be aware of the most recent report, Why Asthma Still Kills. Furthermore, as part of their scope of practice, midwives should ensure that all women have access to personalised asthma action plans, and should work across the multidisciplinary team to promote smoking cessation, infection control and vaccination against influenza. Importantly, midwives should assess compliance with women's prescribed short- and long-acting asthma medication.

Midwives will be aware that pregnant women are reflective of the society in which they live. This incudes the prevalence of medical conditions; therefore, it is useful to set the context for asthma as a respiratory condition.

Asthma has been defined as:

‘A heterogeneous disease usually characterised by chronic airway inflammation. It is defined by the history of respiratory symptoms such as, wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation.’

Moderate/severe disease is associated with poor outcomes and is defined as:

‘Patients who have no clinical improvement with initial standard therapy and those whose presenting peak expiratory flow is less than 25%–30% of predicted’

The hypothesis regarding the aetiology of asthma is associated with an immature neonatal immune system, which prompts an exaggerated response to an allergen (Borish, 2016).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • Unlimited access to the latest news, blogs and video content

  • Monthly email newsletter