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The article presents abstracts on medical topics, which include a study of microRNAs (miR) expression abnormalities in asthmatic epithelial cells, a study on a novel Ex vivo perfusion system for investigating mucous metaplasia in mouse airways, and a study on a sheep model to determine the effects of maternal asthma on fetal outcomes.

Objective: To determine if there are sex differences in risk and incidence of stillbirth, preterm delivery and small-for-gestational age (SGA) in pregnancies complicated by maternal asthma relative to a non-asthmatic population. Study design: Univariant and multiple regression analysis of the incidence of preterm delivery, SGA and stillbirth in singleton pregnancies complicated by asthma in Newcastle, NSW, Australia, from 1995 to 1999. Results: Asthma complicated 12% of all singleton pregnancies. The incidence of preterm delivery was not significantly different between asthmatic (13%) and non-asthmatic (11%) pregnancies. Male fetuses (53%) were more likely to deliver preterm than female fetuses (47%) in both asthmatic and non-asthmatic populations. There were significantly more male neonates of pregnancies complicated by asthma that were SGA at term relative to those of the non-asthmatic population. There were significantly more preterm female neonates that were SGA in pregnancies complicated by asthma relative to those of the non-asthmatic population. Male fetuses were more likely to be associated with a stillbirth in pregnancies complicated by asthma than female fetuses. Conclusion: The presence of maternal asthma during pregnancy increases the risk of stillbirth for the male fetus and is associated with changes in fetal growth, but does not increase the incidence of a preterm delivery. [ABSTRACT FROM AUTHOR]

The article discusses the etiology, epidemiology and risk factors of asthma during conception, childhood and adulthood. It notes that smoking, stress and use of antibiotics during pregnancy are causes of asthma for pregnant women. Lung function, use of antibiotics and exposure to tobacco smoke are associated with asthma in childhood. Recurrence of asthma in childhood, exposure to substances that may cause asthma in workplace and smoking of tobacco and marijuana cause asthma during adulthood.

The T-helper 2 (TH2) bias associated with pregnancy may predispose the pregnant mother to the development or exacerbation of allergic disease. To determine the effects of pregnancy on pre-existing maternal sensitization, we sensitized BALB/c mice before breeding by two intratracheal aspiration (IA) exposures to the fungal allergen, Metarhizium anisopliae crude antigen (MACA). Some mice also received three IA exposures to MACA on gestational days 11, 15, and 19. After weaning, all mice were challenged IA with MACA before killing. To determine the effects of pregnancy on susceptibility to future sensitization, naïve parous and nulliparous BALB/c mice were sensitized by three IA exposures to MACA or to Hank’s buffered salt solution vehicle control. Pregnancy did not have a significant effect on individual inflammatory parameters (airway responsiveness to methacholine, total serum and bronchoalveolar lavage fluid (BALF) IgE, BALF total protein, lactate dehydrogenase activity, and total and differential cell counts) following allergen challenge in sensitized mice, regardless of post-breeding allergen exposure. In conclusion there was a weak inhibition of the overall response in mice exposed to allergen during pregnancy compared to identically treated nulliparous mice. In contrast, parous mice that did not encounter allergen post-breeding tended to have exacerbated responses. Parity had no significant impact on future susceptibility to sensitization. [ABSTRACT FROM AUTHOR]

Background: Microbial colonization of the airways and intestine during birth might have an effect on the risk of asthma and allergic diseases later in life. Objective: We sought to evaluate the association between intrauterine microbial growth at the time of delivery and the development of asthma and allergic sensitization among offspring. Methods: Intrauterine bacterial culture results were recorded at the time of cesarean delivery of 460 children who were born at Kuopio University Hospital during 1990–1992. When the children reached the age of 15 to 17 years, self-administered questionnaires were sent to the mothers, and 382 of the children were also examined by using skin prick tests. Results: Intrauterine growth of potential pathogenic anaerobic bacteria and Streptococcus species at birth was associated with an increased risk of doctor-diagnosed asthma ever (odds ratio [OR], 4.51 [95% CI, 1.56–13.0]; OR, 2.53 [95% CI, 1.19–5.38]) and doctor-diagnosed current asthma (OR, 7.34 [95% CI, 2.44–22.03]; OR, 3.37 [95% CI, 1.46–7.76]) at the age of 15 to 17 years compared with the risk seen in subjects with negative microbial cultures. These findings remained significant also after applying the Bonferroni correction. No significant association after the Bonferroni correction was detected between intrauterine microbial growth and allergic sensitization among offspring. Conclusion: The results of this study indicated that specific intrauterine microbial growth at the time of birth might increase the risk of asthma among offspring through inflammatory mechanisms. These results indicate new potential targets for future studies on the effects of maternal vaginal microflora and intrauterine infection in the development of asthma among children [Copyright &y& Elsevier]

Background: There seems to be an association between paracetamol consumption during late pregnancy and the prevalence of wheezing in infancy and childhood. The aim of the present study is to determine whether the aforementioned association is modified by the presence of asthma in the mother. Methods: A total of 1,741 children aged 3–5 years from an epidemiological survey performed in the province of Murcia (Spain) were included in the analysis. Data on paracetamol consumption (never, at least once during pregnancy or at least once per month during pregnancy), wheezing symptoms in the offspring (according to the International Study of Asthma and Allergies in Childhood protocol) and the presence of asthma in the mother, together with other known risk factors for asthma, were obtained by means of a questionnaire. Results: The mean age of the children was 4.08 ± 0.8 years and 51.1% were males. The overall prevalence of current wheezing was 20.2%. The frequency of paracetamol usage was similar among asthmatic and non-asthmatic mothers, and only a small proportion of them took this drug at least once a month (13.8% of asthmatics and 11.0% of non-asthmatics). Compared to the mothers who never took paracetamol, there was a significant association between the mother having taken paracetamol at least once per month during pregnancy and the offspring suffering from wheezing at preschool age, but only among non-asthmatic mothers (odds ratio 1.94, 95% confidence interval 1.34–2.79 vs. odds ratio 1.05, 95% confidence interval 0.21–5.08). This association was maintained after controlling for potential confounders (odds ratio 1.74, 95% confidence interval 1.15–2.61). Conclusions: The frequent usage of paracetamol during pregnancy is associated with the prevalence of wheezing in offspring during preschool years. Asthma in the mother might modify this association. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article offers information on medical studies on asthma published in journals as of May 2009. One study investigated the risk of perinatal mortality linked with asthma during pregnancy. A study published in the "New England Journal of Medicine" examined whether acid suppression therapy would improve asthma symptoms. Another study determined the relationship between levels of vitamin D in children with asthma and increased risk of hospitalization and airway hyper-responsiveness in Costa Rica.

The article presents abstracts on medical topics which include the evaluation on the patient and clinician satisfaction with Fluticasone/Salmeterol Metered Dose Inhaler with counter (MDIc), relationship between forced exhaled nitric oxide (FeNO) and atopis status in asthmatic pregnant women, and the comparison of two exhaled nitric oxide (eNO) analysers including the EcoMedics CLD88 series and the NiOx.

BACKGROUND: Thirteen studies investigating the association between asthma during pregnancy and perinatal mortality reported generally no increased risk. Most of these studies should be interpreted with caution because they were limited in terms of statistical power. A study was therefore undertaken to evaluate whether maternal asthma during pregnancy increases the risk of perinatal mortality. METHODS: Through three administrative databases from Québec (Canada), a cohort of women with and without asthma who had at least one pregnancy between 1990 and 2002 was formed. Perinatal mortality was identified by diagnostic codes. The adjusted odds ratio (OR) of perinatal mortality in women with and without asthma was compared using Generalised Estimation Equation (GEE) models. The first model included all potential confounders (except small for gestational age, SGA), the second model excluded birth weight, gestational age at birth and SGA and the third model excluded birth weight, gestational age at birth but included only SGA. This analysis was also stratified for birth weight and gestational age at birth. RESULTS: The cohort was formed of 13 100 and 28 042 single pregnancies in women with and without asthma. The crude OR of perinatal mortality was 1.35 (95% CI 1.08 to 1.67), which decreased to 0.93 (95% CI 0.75 to 1.17) after adjustment for birth weight and gestational age at birth. Women with asthma had a higher rate of low birthweight babies and preterm delivery than those without asthma. CONCLUSION: The increased risk of low birthweight babies and premature delivery in women with asthma may partly explain the association between maternal asthma and the increased risk of perinatal mortality. [ABSTRACT FROM AUTHOR]

Asthma has origins in early life. Epidemiological studies show that maternal, more than paternal, asthma significantly increases a child’s risk of developing the disease. Experimental animal models exist which reproduce the increased susceptibility to asthma seen in human studies, and allow analysis of immunotoxic mechanisms that may contribute to neonatal allergy. In addition to maternal asthma, chemically-induced skin contact hypersensitivity or exposure during pregnancy of non-allergic females to certain environmental agents, e.g., air pollution particles, can also result in increased susceptibility to asthma in their offspring. We review here experimental models of maternal transmission of asthma risk, the progress to date in identifying mechanisms, and potential directions for future research. [ABSTRACT FROM AUTHOR]

Background: Asthma is a common condition characterised by wheeze. Many different respiratory sounds are interpreted by parents as "wheeze" in young children. Aim: To relate different respiratory sounds reported as wheeze in 2-year-olds to asthma outcomes at age 5 years. Methods: As part of a longitudinal cohort study, parents completed respiratory questionnaires for their children at 2 and 5 years of age. Parents who reported wheeze were given options to describe the sound as rattling, purring or whistling. Results: Of the 1371 2-year-olds surveyed, 210 had current wheeze, of whom 124 had rattle, 49 purr and 24 whistle. Children with whistle at 2 years were more likely to have mothers with asthma, and children with rattle and purr were more likely to be exposed to tobacco smoke. Wheeze status was ascertained at age 5 years in 162 (77%) children with wheeze at 2 years of age. Whistle persisted in 47% of affected children, rattle in 20%, and purr in 13% (p = 0.023). At 5 years of age, asthma medication was prescribed in 40% with whistle, 11% with rattle, and 18% with purr at 2 years of age (p = 0.017). Conclusions: This study shows different risk factors and outcomes for different respiratory sounds in 2-year-olds: compared with other respiratory sounds, whistle is likely to persist and require asthma treatment in future. [ABSTRACT FROM AUTHOR]

The article explores the prevalence of asthma in pregnant women in the U.S. Asthma is a common, potentially serious medical condition that complicates approximately 4-8% of pregnancies. In general, the prevalence of and morbidity from asthma are increasing, although asthma mortality rates have decreased in recent years.

The article presents abstracts of research on asthma. They include "Use of Inhaled Corticosteroids During the First Trimester of Pregnancy and the Risk of Congenital Malformations Among Women With Asthma," "A Comparison of the Relative Growth Velocities With Budesonide and Fluticasone Propionate in Children With Asthma" and "Bronchiolitis to Asthma: A Review and Call for Studies of Gene-Virus Interactions in Asthma Causation."

Background There is growing evidence that n-3 fatty acids have anti-inflammatory properties and may modulate immune response. Dietary intake of these nutrients during pregnancy could play a role in the risk of asthma and atopy in the offspring. Methods Using data from a cohort of women (n=462) enrolled during pregnancy and whose offspring were followed up to 6 years, we evaluated the impact of fish consumption during pregnancy on the incidence of atopy and asthma. Dietary intake was assessed by food frequency questionnaire (42 items) applied by an interviewer. Results Thirty-four percent of infants had a medical diagnosis of eczema at age 1 year, 14.3% of the children were atopic [based on skin prick test (SPT) at 6 years], and 5.7% had atopic wheeze at age 6 years. After adjusting for potential confounding factors, fish intake during pregnancy was protective against the risk of eczema at age 1 year, a positive SPT for house dust mite at age 6 years and atopic wheeze at age 6 years [odds ratio (OR)=0.73 95% confidence interval (CI) 0.55–0.98, OR=0.68, 95% CI 0.46–1.01 and OR=0.55, 95% CI 0.31–0.96, respectively]. For an increase in fish intake from once per week to 2.5 times per week, the risk of eczema at age 1 year decreased by 37%, and the risk of positive SPT at age 6 years by 35%. Stratification by breastfeeding showed that fish intake was significantly related to a decrease risk in persistent wheeze among non-breastfed children ( P for interaction <0.05). No protective effect was observed among breastfed children. Conclusion Our data suggest a protective effect of fish intake during pregnancy on the risk of atopy-related outcomes. [ABSTRACT FROM AUTHOR]

This article discusses the clinical practice implications of the management of asthma in pregnancy. The authors mention the prevalence of asthma in pregnancy and how each condition affects the other. The use of pharmacology to treat asthma in pregnant women is discussed. The effect of asthma on labor and delivery is considered. The authors recommend that asthma exacerbations be treated aggressively if they occur during pregnancy and that they should be controlled with optimal asthma management. Drug treatments should be assessed with asthma control criteria.

Objective The combined contribution of neonatal, perinatal, and maternal health, demographic, environmental, and family psychosocial factors to early onset asthma and wheezing in a healthy birth cohort was examined. Methods Participants included 1,158 ethnically and socioeconomically diverse parents of 2- and 3-year olds who completed mailed questionnaires. Results Asthma and wheezing prevalence was 8.4 and 8.1%, respectively. Asthma during pregnancy, smoking in the home, and being male increased risk for asthma diagnosis and wheezing whereas social support minimized risk for both. Shorter gestational age, exposure to violence, and maternal anxiety increased risk for wheezing. The negative impact of smoking in the home was greatest for children with shorter gestational ages and mothers with asthma during pregnancy. Conclusion Findings confirm and extend previous work documenting demographic risks and highlight smoking, violent events, and social support in early onset asthma and wheezing. Findings illustrate the need for ecologically based interventions to treat asthma and wheezing in young children. [ABSTRACT FROM AUTHOR]

Abstract: Pregnant women with asthma are frequently exposed to synthetic glucocorticoids and glucocorticoids are known to reduce fetal growth. The fetus is normally protected from the harmful effects of maternally derived glucocorticoids by the placental enzyme 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2). Whether 11β-HSD2 inactivates the synthetic glucocorticoids used for asthma treatment during pregnancy (budesonide, beclomethasone dipropionate and fluticasone propionate) remains unknown. To investigate the relationship between steroid use during pregnancy and fetal growth and development, pregnant women with (n =119) and without asthma (n =84) were followed throughout pregnancy. Data on asthma medication use, neonatal size at birth, placental weight and cord blood cortisol and estriol were collected. Placental tissue samples were collected from non-asthmatic women (n =8) for metabolism studies. Placental 11β-HSD2 activity was determined using beclomethasone dipropionate, budesonide, fluticasone propionate, prednisolone, dexamethasone and betamethasone as steroid substrates. Steroids and their oxidised metabolites were examined using thin layer chromatography and densitometry. Placental 11β-HSD2 metabolised beclomethasone, prednisolone, dexamethasone and betamethasone, but not budesonide or fluticasone. No association between the use of inhaled steroids for asthma treatment during pregnancy and alterations in neonatal size, placental weight, gestational age at delivery, or umbilical vein estriol concentrations was demonstrated compared to non-asthmatic women. In conclusion, the use of inhaled steroids for asthma treatment does not affect fetal growth, despite differences in placental metabolism by 11β-HSD2. [Copyright &y& Elsevier]

The article discusses the occurrence of asthma in pregnancy. Asthma may be associated with increased prematurity, need for cesarean delivery, preeclampsia, growth restriction, other perinatal complications, maternal morbidity and mortality. Asthma management include lung function monitoring, patient education and individualized pharmacologic therapy.

Studies have shown that pregnancy can alter the pathophysiology of a pre-existing maternal disease such as asthma. However, the mechanisms that alter maternal asthma during pregnancy are presently unknown. Previous work has demonstrated that human bronchial smooth muscle (BSM) cells produce inflammatory factors in response to nonpregnant, atopic plasma. The aim of this study was to determine whether circulating pregnancy-derived factors in maternal and fetal plasma can stimulate inflammatory mediator release in BSM cells in the presence and absence of maternal asthma. Cultured human BSM cells were exposed to maternal and fetal plasma from normal pregnancies and pregnancies complicated by asthma. Inflammatory mediator release was determined by enzyme-linked immunosorbent assay (ELISA). Both maternal and fetal plasma from asthmatic and nonasthmatic individuals significantly increased production of interleukin (IL)-6 (ANOVA, P <0.001), regulated upon activation, normal T-cell expressed and secreted (RANTES) (ANOVA, P <0.01), and soluble intercellular cell-adhesion molecule-1 (sICAM-1) (ANOVA, P <0.01). There was no difference in inflammatory mediator release in response to asthma and nonasthmatic plasma. Eotaxin release was increased by pregnant asthmatic plasma (ANOVA, P <0.05). The results of this study suggest that circulating pregnancy-related factors can activate asthma-associated mediators in BSM cells. This change in BSM function may be one mechanism that contributes to increased asthma severity during pregnancy. [Copyright &y& Elsevier]

The article examines the possible association of maternal obesity with pulmonary and nonpulmonary pregnancy complications in asthmatic women. Results indicate that obesity is associated with an increased risk of asthma exacerbations during pregnancy. The increased rate of nonpulmonary complications is associated with obesity in the sampled population.

Objective: The objective of the study was to determine whether women alter their use of asthma medications during pregnancy. Study design: Weekly asthma medication use was determined from prescription claims data in a cohort of 112,171 pregnant women aged 15 to 44 years who were continuously enrolled in the Tennessee Medicaid program prior to their singleton pregnancy and who delivered a singleton birth during 1995 to 2001. Change in asthma medication use was evaluated using generalized estimating equation analyses. Results: Women with asthma significantly (P < 0.0005) decreased their asthma medication use from 5 to 13 weeks of pregnancy. During the first trimester, there was a 23% decline in inhaled corticosteroid prescriptions, a 13% decline in short-acting beta-agonist prescriptions, and a 54% decline in rescue corticosteroid prescriptions. Conclusions: Utilization of all categories of asthma medications decreased in early pregnancy, with the largest declines occurring for inhaled and rescue corticosteroids. [ABSTRACT FROM AUTHOR]

As clinical experience with omalizumab increases, questions arise from clinicians that are not answered in the product insert or clinical reports. How does this drug really work? There surely must be more than the simple reduction of free IgE which, in and of itself, causes no disease. Can omalizumab be used in patients whose IgE level is below 30 or above 700 IU/mL? Can you treat a pregnant asthmatic woman with omalizumab? What are the updated risks for cancer? Is there a risk for omalizumab-treated patients who travel to parasite-endemic areas? What are the implications of skin-prick tests that remain positive after treatment? Does this drug prevent anaphylaxis with enough assurity to use it in conjunction with immunotherapy (IT) or rush IT? Are the complexes formed as a result of therapy problematic, therapeutic, or inconsequential? How long should this drug be used? It is the purpose of this review to examine these clinical issues and present common strategies for approaching each. [ABSTRACT FROM AUTHOR]

Asthma is the most common respiratory complication of pregnancy and affects approximately four per cent of all pregnant women. The purpose of this study was to establish normative data regarding how peak flow values change during gestation in pregnant women with asthma. Eighteen pregnant women with asthma were recruited and completed daily logs throughout their pregnancies. The findings suggest there is a difference in peak flow values in different trimesters. Specifically peak flow values were highest in the second trimester with significant differences between the second and third trimesters. While the sample size is small it does provide longitudinal data that suggest changes in asthma as the pregnancy progresses. This study represents a logical next step in identifying the impact of pregnancy on asthma. [ABSTRACT FROM AUTHOR]

Bronchial asthma is one of the most common maternal diseases complicating pregnancy. We assessed the risks of congenital abnormalities in a case-control population-based analysis using the dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996. Of the 22,843 cases with congenital abnormalities, 511 (2.2%) had mothers with bronchial asthma, while of the 38,151 matched control subjects without congenital abnormalities 757 (2.0%) had mothers with bronchial asthma (unadjusted prevalence odds ratios [POR] 1.2; 95% CI: 1.0-1.3). In all mothers with bronchial asthma, a higher incidence of respiratory tract infections and higher drug intake could be observed. In the case group of medically recorded bronchial asthma, a slightly increased risk for club foot has been revealed. However, this weak association could be explained by the higher proportion of preterm births in this group. The main limitation of the analysis was that at the time of data collection only a small proportion of pregnant mothers were using anti-asthma medications recommended by the actual guidelines. [ABSTRACT FROM AUTHOR]

Objective and background: The course of asthma may be altered during pregnancy with at least one-third of women experiencing a worsening of asthma and 20% having an exacerbation during pregnancy. This study used the novel proteomic technique, surface-enhanced laser desorption ionization-time of flight mass spectrometry to determine if the presence of asthma during pregnancy was associated with alterations in plasma proteins. Methods: Plasma collected from healthy ( n = 23) and asthmatic ( n = 27) pregnant women at 18 and 30 weeks gestation was applied to strong anion exchange (SAX2), weak cation exchange (WCX2) and immobilized metal affinity capture (IMAC-Cu2+) chips. Mass analysis was conducted using Ciphergen Protein Biology System IIc and significant differences in individual peak intensities between groups determined. Results: At 18 weeks gestation, 91 peaks were significantly different between pregnant women with and without asthma, representing 28% of the total peaks identified. At 30 weeks gestation, 51 peaks were significantly different. There were two peaks that were significantly different between groups at both 18 and 30 weeks gestation and expressed at a similar level at both time points. One was increased in asthmatics (MW = 6444 Da) whereas the other decreased in asthmatics compared with non-asthmatic women (MW = 1846 Da). Conclusions: This study demonstrated that there are differences in protein patterns between pregnant women with and without asthma. Other techniques are needed to define the molecular species and classify pathophysiological significance. Surface-enhanced laser desorption ionization-time of flight mass spectrometry has potential as a tool to monitor disease progression in situations such as pregnancy. [ABSTRACT FROM AUTHOR]

This article presents an overview of the guidelines for the management of pregnant women with asthma. Emphasis is placed on the National Asthma Education and Prevention Program guidelines. [ABSTRACT FROM AUTHOR]

Our previous work has demonstrated that alterations in placental function are associated with changes in fetal development in pregnancies complicated by asthma. The pathophysiology of asthma in adults and children and intrauterine growth restriction during pregnancy are associated with oxidative stress. Based on this information, we examined whether placental anti-oxidant pathways and markers of biological oxidation were altered in pregnancies complicated by asthma. Anti-oxidant enzyme activities of superoxide dismutase, glutathione peroxidase and thioredoxin reductase, thioredoxin concentrations, lipid and protein oxidation levels were measured in placentae of pregnancies complicated by asthma and compared to uncomplicated, non-asthmatic pregnancies. Placental tissue homogenates of pregnancies complicated by asthma demonstrated significantly increased levels of lipid peroxidation (25.7±1.8μmol/mg protein versus 12.1±1.6μmol/mg protein, P =0.008) and protein carbonyl concentrations (414.6±51.4units/mg protein versus 222.3±32.6units/mg protein, P =0.0032) when compared to non-asthmatic controls. The activities of the anti-oxidant proteins superoxide dismutase (2.17±0.09 units/mg protein versus 1.67±0.09 units/mg protein, P =0.014) and thioredoxin reductase (54.0±6.9 units/mg protein versus 28.7±6.0 units/mg protein, P =0.009) were significantly increased in the presence of maternal asthma. Placental thioredoxin levels (102.9±5.3ng/mg protein versus 92.9±8.6ng/mg protein, P =0.37) and glutathione peroxidase activity (27.3±2.2mmol/min/mg protein versus 28.3±2.2mmol/min/mg, P =0.83) were not significantly different in pregnancies complicated by asthma and non-asthmatic pregnancies. There was no effect of fetal sex, asthma severity or treatment for asthma on these pathways. Maternal asthma during pregnancy is associated with increased placental enzymatic anti-oxidant capacity and also increased protein oxidation suggesting there is a compensatory increase in anti-oxidant activity in response to increased oxidative stress. [Copyright &y& Elsevier]

Background Pregnancy frequently interferes with the course of bronchial asthma, and asthmatic pregnant women experience less successful pregnancies. T lymphocytes synthesizing IL-4 or IFN-γ are important in allergic mechanisms of the airways as well as in materno-fetal immunity. Objective We hypothesized that pregnancy (a T helper-2 polarized state) of asthmatics will enhance the number of circulating T2 lymphocytes, but decrease the subset-producing IFN-γ (T1 lymphocytes) and thereby cause a culminating T2 dominance with possible clinical consequences. Methods IL-4- or IFN-γ-producing T lymphocytes were determined by flow cytometry in healthy ( n=8) and asthmatic ( n=13) non-pregnant women and healthy ( n=18) and asthmatic ( n=48) pregnant women of similar chronological and gestational (2nd–3rd trimester) age and asthma severity (Global Initiative for Asthma II–III). Results In the blood of non-pregnant women – healthy or asthmatic – the numbers of IL-4- and IFN-γ+ T cells were very low (<10/μL blood). In contrast, in asthmatic pregnant women, the cell counts were 182±27 and 39±6 for IFN-γ+ and IL-4+ T cells/μL blood, respectively (both P<0.05 vs. respective control values of non-pregnant asthmatics). Within the asthmatic pregnant group, significant negative correlations were revealed between the numbers of IFN-γ+ or IL-4+ T cells and maternal peak expiratory flow as well as birth weight of newborns (both P<0.05). Conclusion These data show a previously unknown immunological interference between asthma and pregnancy. The culminating proliferation of IFN-γ+ and IL-4+ T lymphocytes may potentially impair maternal airway symptoms as well as fetal development. [ABSTRACT FROM AUTHOR]

Objective . To study the association between bronchial asthma during pregnancy and gestational age/birth weight, and also preterm birth and low birth weight. Method .In the population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980–1996, controls without congenital abnormalities were analysed. Results . Of 38,151 newborn infants, 757 (2.0%) had mothers with bronchial asthma during pregnancy, 88% were medically recorded prospectively. Mothers with bronchial asthma in pregnancy had 0.6 week shorter gestational age and a higher proportion of preterm births (14.1% vs. 9.1%). These findings were reflected with a lower mean birth weight (3,102 vs. 3,279 gram) and higher proportion of low birth weight newborns (9.0% vs. 5.6%). Conclusion . The old fashioned anti-asthmatic drugs were not able to prevent the bronchial asthma-related preterm birth, thus there is an urgent need to use modern inhaled therapies. [ABSTRACT FROM AUTHOR]

Objective: Little is known about racial differences in asthma outcomes during pregnancy. We performed a cohort study to estimate racial differences in maternal asthma outcomes in a low-income population of pregnant women in which blacks and whites have similar medical care access and benefits. Methods: We conducted a population-based cohort study of asthma-related morbidity in black and white pregnant women enrolled in Tennessee's Medicaid Program, TennCare. Pregnant women were identified through TennCare enrollment files linked to birth certificates, 1995–2001. Prepregnancy, women with asthma were identified using International Classification of Diseases, 9th Revision, codes for health care visits and pharmacy files for asthma medication. Adjusted relative rates (RR) of rescue cortico-steroid prescriptions, emergency department (ED) visits, and hospitalizations during pregnancy were compared by race using Poisson regression. Results: We identified 4,315 women with asthma (4%) from a population of 112,171 pregnant women of black or white race with at least 180 days of continuous enrollment in TennCare before pregnancy. Blacks were more likely to receive a course of rescue corticosteroids than whites (14.6% versus 11.9%, adjusted RR 1.35, 95% confidence interval [CI] 1.14–1.61), have an emergency department visit (16.7% versus 8.7%, adjusted RR 1.89, 95% CI 1.57–2.27), or be hospitalized for asthma (9.0% versus 5.2%, adjusted RR 1.73, 95% Cl 1.34–2.24). Conclusion: Pregnant women with asthma had high asthma-related morbidity. Black women had clinically significantly more morbidity than whites. There is a need to improve the medical care of low-income women with asthma, particularly black women. [ABSTRACT FROM AUTHOR]

Objective: We conducted a comparative proteomic analysis of placental and umbilical cord blood proteins using surface-enhanced laser desorption ionization-time of flight mass spectrometry (SELDI-TOF MS) to examine the associations among asthma, fetal gender, and protein profiles. Methods: Placental tissue and umbilical vein plasma were collected from 10 healthy and 20 asthmatic women. Placental proteins were extracted using phosphate-buffered saline containing protease inhibitors. Samples were applied to the surfaces of strong anion exchange (SAX2), weak cation exchange (WCX2) and immobilized metal affinity capture (IMAC-Cu2+) chips. Mass analysis was conducted using a Ciphergen Protein Biology System IIc (Freemont, CA), and differences in individual peak intensities between groups were determined. Results: Fourteen placental peaks were significantly different between asthmatic and non-asthmatic women (seven more highly expressed and seven less highly expressed). Ten umbilical cord blood peak differences were identified, with four peaks more highly expressed and six peaks less highly expressed in asthmatics. Four placental and three umbilical cord blood proteins differed significantly between male and female fetuses. Two placental and five umbilical cord blood peaks were specifically increased in a subgroup of samples collected from asthmatic women who did not use inhaled glucocorticoids and were pregnant with a female fetus, a group previously found to have altered placental function. Conclusions: This study demonstrates the abilities of the SELDI technique as a tool for protein profiling in tissue or plasma. Further work to positively identify the candidate peptides found in this study may provide a greater understanding of the placental mechanisms leading to alterations in fetal growth in patients with bronchial asthma. [Copyright &y& Elsevier]

Asthma is a common and potentially serious condition complicating pregnancy. However, the literature available on the management of severe asthma in pregnancy is limited. We describe two episodes of respiratory failure due to asthma in pregnant women and discuss their management in the context of a review of the literature. In both patients, adequate oxygenation was maintained by using controlled hypoventilation with a permissive hypercapnia strategy. Both patients received aggressive steroid therapy, aerosolized bronchodilators, sedation, and paralysis. Aggressive asthma treatment as in a nongravid female is recommended. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to study the effects of gestational age and maternal position on peak expiratory flow rates. METHODS: Peak expiratory flow rates were measured in the standing, sitting, and supine positions in 38 healthy pregnant women at 4-week intervals starting at less than 10 weeks until delivery and again at 6 weeks postpartum. The highest reading of 3 consecutive peak expiratory flow rate measurements for each encounter and position was used in the analysis. Repeated measures analysis of covariance was performed with subjects, gestational age, position, and gestational age times position as the model effects. Least squares mean peak expiratory flow rates were compared among positions at different gestation ages using Bonferroni-adjusted least significant difference t tests. RESULTS: Peak expiratory flow rate declined significantly throughout gestation in all positions (P – .001) with mean rate of decline of 0.65 L/min per week). The slopes of linear trends were not statistically different between positions (P = .222). However, the rate of decline for the supine position was higher than for standing and sitting positions (0.86 compared with 0.46 and 0.57 L/min per week), respectively. On average, the postpartum peak expiratory flow rate returned to 71.9% of its measurement in early gestation. Nomograms depicting mean and the 5th and 95th percentiles of peak expiratory flow rates were constructed for each position. CONCLUSION: Peak expiratory flow rate measurements are affected by maternal position and advancing gestational age, especially in the supine position. Adjustment of patient's flow rate in relation to gestational age and maternal position is recommended, especially in pregnant women with asthma. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to educate physicians on the safety of asthma controller use during pregnancy. Study design: A comprehensive literature search using MEDLINE, the Cochrane Controlled Trials Register and Database of Systematic Reviews, EMBASE, and selected bibliographies identified human gestational studies of asthma controller medications from which maternal and fetal outcomes were obtained. The US Food and Drug Administration (FDA) pregnancy category ratings were identified from product package inserts. Results: Human gestational studies were identified for the inhaled corticosteroids (ICSs) beclomethasone, budesonide, and triamcinolone and for cromolyn sodium, theophylline, and salmeterol. Human pregnancy data support an FDA Pregnancy Category B rating for budesonide. Pregnancy Category B ratings for cromolyn, nedocromil, montelukast, and zafirlukast are based primarily on safety in animal reproduction studies. ICSs other than budesonide, theophylline, zileuton, and long-acting β2-adrenergic agonists are Pregnancy Category C. Conclusion: Human pregnancy data for many asthma controllers are lacking; nonetheless, data support a range of choices among medications rated Pregnancy Category B. [ABSTRACT FROM AUTHOR]

Objective To determine whether the use of inhaled corticosteroids during pregnancy increases the risk of pregnancy induced hypertension and pre-eclampsia among asthmatic women. Design Nested case-control study. Setting Three administrative health databases from Quebec: RAMQ, MED-ECHO, and Fichier des événements démographiques. Participants 3505 women with asthma, totalling 4593 pregnancies, between 1990 and 2000. Main outcome measures Pregnancy induced hypertension and pre-eclampsia. Results 302 cases of pregnancy induced hypertension and 165 cases of pre-eclampsia were identified. Use of inhaled corticosteroids from conception until date of outcome was not associated with an increased risk of pregnancy induced hypertension (adjusted odds ratio 1.02, 95% confidence interval 0.77 to 1.34) or pre-eclampsia (1.06, 0.74 to 1.53). No significant dose-response relation was observed between inhaled corticosteroids and pregnancy induced hypertension or pre-eclampsia. Oral corticosteroids were significantly associated with the risk of pregnancy induced hypertension (adjusted odds ratio 1.57, 1.02 to 2.41), and a trend was seen for pre-eclampsia (1.72, 0.98 to 3.02). Conclusion No significant increase of the risk of pregnancy induced hypertension or pre-eclampsia was detected among users of inhaled corticosteroids during pregnancy, while markers of uncontrolled and severe asthma were found to significantly increase the risks of pregnancy induced hypertension and pre-eclampsia. [ABSTRACT FROM AUTHOR]

Objective: Prostaglandin E2 is a pharmacologic agent that is used commonly in obstetrics; however, its usage in patients with asthma is unclear. The study objective was to examine pregnant patients with asthma who received prostaglandin E2. Study design: All pregnancies that were given prostaglandin E2 suppositories and/or gel were recorded prospectively from January 1989 through December 2000. Those cases with a history of asthma or active asthma were analyzed for any clinical evidence of disease exacerbation after the administration of the agent. Clinical exacerbation was defined as any respiratory complaint that followed drug usage, the initiation of bronchodilator medications by patients currently not on therapy, or an increase in bronchodilator usage by patients with active disease. Results: During the study period, 2513 patients received treatment with the cervical ripening gel, of whom 158 patients had a history of asthma or active asthma. Additionally, 536 patients were administered the 20-mg suppositories, of whom 31 patients had a history of asthma or active asthma. Thus, a total of 189 patients with a history of asthma or active asthma were exposed to prostaglandin E2, and none of the patients had any evidence of a clinical exacerbation of the disease (0/189 cases; 95% CI, 0- 2%). Conclusion: Based on the 95% CI of these data, the maximum risk for the development of a clinical exacerbation of asthma, if exposed to the obstetric forms of prostaglandin E2, is ≤2%. Although all drug usage in patients with asthma should be monitored carefully, this information would support the usage of prostaglandin E2, if obstetrically indicated, in pregnant patients with asthma. [ABSTRACT FROM AUTHOR]

Deals with asthma in adults and examines the complications that cause death. Causes of asthma; Asthma attack classifications; Causes of asthma; Analysis of the emergency care given to a pregnant patient experiencing acute asthma.

Several physiological changes occur during pregnancy that could worsen or improve asthma, but it is not clear which, if any, are important in determining the course of asthma during pregnancy. In a large cohort study, the most severe symptoms were experienced by patients between the 24th and 36th week of pregnancy. Thereafter, symptoms decreased significantly in the last four weeks and 90 percent had no asthma symptoms during labour or delivery. Of those who did, only two patients required anything more than inhaled bronchodilators.

Objective: To compare pregnancy outcome in asthmatic and non-asthmatic patients from high altitudes. Method: A prospective case-control study over a 4-year period. The setting was: Abha Maternity Hospital, south-west region of Saudi Arabia. Eighty-eight asthmatic pregnant patients were followed up on during their pregnancies and deliveries (cases). The control subjects were 106 non-asthmatic patients who delivered during the same period. Results: There were no statistically significant differences in the mean age, parity and gestation at delivery between the cases and control subjects (P>0.05), while there were statistically significant differences in the mean birth weight, placental weight and number of abortions between the two groups (P<0.05). Antenatal complications occurred in 12.5% of the asthmatic patients and 1.9% of the control subjects. Pre-eclampsia was diagnosed in 7.9% of the asthmatic group but in none of the control subjects. Induction of labor, cesarean section rate, perinatal mortality, congenital malformations and Apgar score <7 at 5 min were significantly higher in the asthmatic patients. Conclusion: Asthma occurring in pregnancy was associated with increased antenatal complications, increased perinatal loss and congenital malformations in our study population. [Copyright &y& Elsevier]

Asthma, a chronic inflammatory disease of the airway system, is the most common respiratory complication that can impact pregnancy. Various physiologic changes in gestation may variably affect this pulmonary disease. The cornerstone of management involves implementing strategies and treatments that assist in maintaining normal maternal pulmonary function, thereby preventing fetal complications. Optimum therapy can provide a favorable outcome for both mother and fetus. [ABSTRACT FROM AUTHOR]

Objective: We examined the relationship between asthma during pregnancy and selected infant and maternal outcomes. Study Design: A retrospective cohort study was conducted on mother-infant dyads identified from a linked infant and maternal hospital discharge database in the Canadian province of Quebec between fiscal years 1991-1992 and 1995-1996. Mothers with asthma (n = 2193) were compared with a randomly selected control sample (n = 8772) from the remaining population of mothers. Results: After important confounding variables were accounted for, maternal asthma was significantly associated with several adverse infant outcomes, including preterm birth and birth of infants who are very small for gestational age, and adverse maternal outcomes, such as idiopathic preterm labor, early idiopathic preterm labor, preeclampsia, transient hypertension of pregnancy, pregnancy-associated hypertension, chorioamnionitis, and cesarean delivery. Conclusion: Our results demonstrated that pregnant women with asthma are at substantially increased risk for several adverse infant and maternal outcomes and suggest the need for extra attention to mothers with asthma and their infants. (Am J Obstet Gynecol 2001;184:90-6.) [ABSTRACT FROM AUTHOR]

Objectives:To provide physicians with current guidelines for the diagnosis and optimal management of asthma in children and adult, including pregnant women and the elderly in office emergency department hospital and clinic settings. Options:The consensus group considered the roles of education, avoidance of provocative environmental and other factors, diverse pharmacotherapies, delivery devices and emergency and in-hospital management of asthma. Outcomes:Provision of the best control of asthma by confirmation of the diagnosis using objective measures rapid achievement and maintenance of control and regular follow-up. Evidence:The key diagnostic and therapeutic recommendations are based on the 1995 Canadian guidelines and a critical review of the literature by small groups before a full meeting of the consensus group. Recommendations are graded according to 5 levels of evidence Differences of opinion were resolved by consensus following discussion. Values:Respirologists, immunoallergists, pediatricians and emergency and family physicians gave prime consideration to the achievement and maintenance of optimal control of asthma through avoidance of environmental inciters, education of patients and the lowest effective regime of pharmacotherapy to reduce morbidity and mortality. Benefit, harms and costs:Adherence to the guidelines should be accompanied by significant reduction in patients' symptoms reduced morbidity and morality, fewer emergency and hospital admiring fewer adverse side-effects from medications better quality of life for patients and reduced costs. Recommendations:Recommendations are included in each section of the report. In summary, after a diagnosis of asthma is made based on clinical evaluation, including demonstration of variable airflow obstruction, and contributing factors are identified a treatment plan is established to obtain and maintain optimal asthma control. The main components of treatment are patient education, environmental control, p... [ABSTRACT FROM AUTHOR]

Presents recommendations from the Canadian medical community on the best ways to manage asthma. General principles of asthma care; Drug therapy; Environmental control; Patient education; Immunotherapy; Drug therapy; Delivery devices; Asthma in the elderly; Asthma in pregnancy; Emergency management of asthma; Hospital patients with acute asthma.

Investigates the relationship between the prevalence of asthma and smoking during pregnancy. Prevalence of asthma during pregnancy; Higher likelihood of smoking during pregnancy among current asthmatics than non-asthmatics; Implications for developing programs aimed at discouraging women from smoking during pregnancy.

The article focuses on the recommendations for the diagnosis and management of asthma in children and adults. The article presents the aspects of asthma care including control of environmental factors affecting patients and drug therapy. Patients must also be given access to health education. Some considerations for the treatment of asthma in pregnant are mentioned. The emergency management of asthma is also discussed.

Presents information on a study which examined the relationship between transient tachypnea of the newborn and asthma complicating pregnancy. Methodology used; Relationship between asthmatic mothers and their infants; Significance of the study results.

Discusses the management of a pregnant woman with asthma. Effect of pregnancy on asthma; Alterations in pulmonary mechanics with pregnancy; Information on fetal oxygenation; Details of antiasthmatic agents for pregnant women.