The management of asthma and rhinitis during pregnancy.

Asthma and rhinitis frequently complicate pregnancy. The course of asthma may be adversely altered by gestation, placing the mother and fetus at risk. Therefore, pregnant patients with persistent asthma require an aggressive asthma management plan that includes environmental control measures and the use of long-term controller medications. Inhaled corticosteroids (ICSs) are the preferred long-term controller medication for persistent asthma, based on efficacy. However, safety concerns regarding corticosteroids may cause physicians or patients to seek an alternate, less effective treatment during pregnancy. The Food and Drug Administration's pregnancy category ratings are based on animal and human safety data. Because ICSs were previously rated pregnancy category C (i.e., with human studies lacking and animal studies either lacking or positive for fetal risk), other asthma controllers, such as cromolyn and nedocromil, that carry a pregnancy category B rating (i.e., showing no evidence of fetal risk in humans or animal studies negative for fetal risk) appeared to be more desirable for use during pregnancy. One ICS, budesonide, was reclassified as pregnancy category B based on human data supporting its use during pregnancy. In moderate and severe persistent asthma, add-on therapy may be considered, including long-acting beta2-adrenergic agonists, leukotriene receptor antagonists, and theophylline. Because rhinitis may adversely affect quality of life and the course of asthma, recommendations for aggressive management also apply.

Viral respiratory infections in association with asthma and sinusitis: a review.

OBJECTIVE: Viral respiratory infections (VRIs) commonly precede asthma exacerbations in both children and adults. Likewise, VRIs may affect the paranasal sinuses, predisposing infected individuals to the development of subsequent acute bacterial sinusitis. This article discusses the role that viruses play in both the development of asthma and in acute asthma exacerbations. Mechanisms by which viral infections provoke asthma exacerbations are reviewed, and treatment of such episodes is discussed. The pathogenesis of sinusitis and association with VRIs is reviewed along with treatment recommendations. DATA SOURCES: Relevant articles in the medical literature were reviewed with sources including randomized, controlled clinical trials, review articles, epidemiologic studies, and standard textbooks in allergy and immunology. CONCLUSIONS: This review highlights the prominent role that viral pathogens (especially rhinovirus) play in exacerbation of asthma and in the development of sinus disease. The specific mechanisms whereby viral infection leads to an acute asthma exacerbation or to subsequent bacterial sinusitis are described. Treatment options are outlined including the potential future application of antiviral compounds.