Asthma and chronic rhinitis in pregnancy

[sciencepotato]

Hi all,

I've been wondering how those of you struggling with asthma and chronic nasal congestion managed during pregnancy.Did you continue use of nasal antihistamine and steriod spray in pregnancy too? My doctors officially advise only saline spray citing the lack of research on the medication but it's of course useless in my chronic condition. Any experience would be appreciated. I understand of course that it's just sharing the experience and not giving medical advice :)

Im asthmatic and have a chronic blocked nose which is caused my inflammation and polyps.
I now have a 4 month old but throughout my pregnancy I continued all my asthma drugs as normal (Bricanyl and Budesonide/Formoterol).
I find the only thing that helps me breathe and stop the constant nasal drip is Sudafed Blocked Nose Spray which is just bought off of the shelf.
GP advised against it purely as it (like many drugs) hasnt been tested widely on pregnant women.
GP gave me a steroid instead at a low dose which did absolutely nothing.
I was advised that if the benefits of the Sudafed outweigh the risks then I could continue using it but at a reduced amount.
The benefit to me was being able to breathe and sleep, the risk is minimal as it is not systemic as such and the dose is tiny.
Needless to say I continued using it all the way through my pregnancy and my daughter is fine. I did really have to think long and hard about thus though.
I wouldnt tell anyone else to do this without a long chat with their GP first but i couldnt go 9 months not being abke to breathe at all.

It's such a great news that your ivf treatment has worked. I am doing ivf/icsi too but have always been advised by my fertility advisor to continue all my asthma medication and she's an asthmatic herself. I cannot imagine going without my asthma inhaler through my day, as it helps me breathe. If you don't mind me asking, what was the rationale for you to reduce the use of asthma inhalers or did you not need one on the regular basis before pregnancy?

Redherring, I so much hate this chronic blocked nose issue and especially combined with asthma, it sucks! Have you ever consulted an ENT regarding this? Wondering if they might have some long term solution to this, as frankly living with asthma is hard enough, and with blocked nose it's by worse by magnitude. Isnt Sedafed a decongestant spray though?

I am grateful for sharing your experience, I cannot imagine going without my asthma medication through the day. Are/were you on montelukast too?

I’ve got chronic post nasal drip and mild cough variant asthma, so am still using Nasonex (mometasone spray).

I’m dual nationality and Australian advice is that steroid (budesonide and mometasone) nasal sprays are quite safe, partly because the risks of steroids for asthma in pregnancy is well researched.

I read some slightly worrying research pre pregnancy about the use of systemic antihistamines so have chosen to avoid these - I would ordinarily take Fexofenadine during spring.

This is also an IVF baby after 6 rounds so I’m certainly also invested in not doing baby any harm.

I’ve have stepped up use of my Neilmed nasal rinse kit as I find getting rid of the mucus buildup twice a day to be really helpful.

[quote FeedMeSantiago]@sciencepotato (great username, btw). I don't have a lung specialist. Only ever seen the GP and asthma nurse. Asthma was first suspected when I was 11. I was diagnosed at 29. Apparently as I don't wheeze it wasn't asthma and I was just unfit... so many GP's said 'it can't possibly be asthma'. The asthma nurse diagnosed me very quickly once I persuaded a GP to get me in front of one.

So in the 4 years since diagnosis I've had 3 courses of prednisolone, 2 in the last month and one in 2019 (given by urgent care who also gave antibiotics for a chest infection).

I'm the same with Montelukast, everytime they take me off it I get worse within a day. Everytime they say I can take 2 puffs of Fostair instead of 4 I'm back in for an asthma review in days and back on 4 puffs.

I think the surgery are grumpy because they told me to come off certain meds for pregnancy and then they contacted my Rheumatologist who said my GP's advice was wrong and that the risk of harm to me from not being on the meds was greater than the risk to a baby and I need pain relief as I have 3 chronic pain conditions. GP weren't happy but have prescribed.

So I think they looked again at my other meds and decided that the asthma meds needed to go instead.

I'm ringing asthma uk on Monday.[/quote]
I just read this on www.asthma.org.uk/advice/manage-your-asthma/pregnancy/, basically saying how safe most of asthma meds are. I am sure you've seen it already and perhaps might be worth discussing it when you ring them directly on Monday (very wise)!

Oh absolutely. I do daily saline rinses too, to get rid of the mucus and pollen. But in my case if I don't use nasal steroid afterwards, it cant help me with inflammation and as a result worsening of my asthma :/

Cool, that's good to know that Australian guidelines are in favour of nasal steroids. I am not inclined to drop them even in pregnancy to be honest, as they help my asthma so much. But everyone is different and should consult with the doc they trust on their health.
It's funny you mention fexofenadine. It makes me so sleepy. I am on other antihistamine at the moment and sadly cannot drop it as again my asthma gets worse when I do. Somehow my allergies are not presenting themselves in sneezing, runny nose but straight in asthma symptoms.
Oh and I have a couple of rounds of ivf treatments behind too!
Here is what nhs says on safe antihistamines to use in pregnancy www.nhs.uk/conditions/antihistamines/

I'm ringing asthma UK first thing tomorrow for back up. I have seen that page before. I had an asthma review on 1 April where they said my asthma meds were safe and a review before Covid, when we were initially planning to start trying in summer 2020, which said they were safe.

The asthma nurse I spoke to on Friday is speaking to a senior colleague on Monday and will call me back so I will flag whatever asthma uk say. At least my pharmacist also backs me up (she's a good egg).

Pharmacist had to calm me down on Friday and tell me to go home and rest. I just can't fathom why the GP surgery chose to stress someone having an asthma exacerbation out like this instead of waiting until I was better. I still feel rotten with this chest infection so am trying to take it easy today and take action tomorrow.

I will also try and speak to my regular asthma nurse as she has looked after me for years and knows I look after my asthma and will back me up - I always come in when it worsens, I record every additional puff, the trigger etc. I haven't visited family for years as their smokey houses triggers my asthma.

It's also annoying me that my asthma was brilliant during Covid. I wasn't exposed to cigarette smoke from friends and family, less pollution, no colds etc. Apart from Covid which gave me a chest infection, I can count on one hand how many reliever puffs I needed from March 2020 - October 2021.

I'm now on sulfasalazine (since July) for my arthritis and am getting colds and that is worsening my asthma. Hopefully as I get used to doing more and getting exposure to bugs my immune system will improve.

Sounds like horror,.you gp practice. It's great you're calling tomorrow and if you don't trust your gp surgery talk to someone else or change them altogether if possible or you want to. Nobody can force you to do or not do anything. In the end it's up for the patient to decide. Don't worry, it'll get sorted. I am truly appaled you are having to go through this. Asthma is always fluctuating, never the same. Have faith it will improve, you just need to find the right combo of meds. And by the sounds of it you need all what you are taking! Glad you're trusting your gut and standing your ground. It will be okay!

@sciencepotato

They shouldn't do no, intranasal is considered topical application, hence dont have systemic effects like oral form does. I was just frustrated that my ENT said no to using dymista in pregnancy since there's enough studies to support it's safety (well it's all great but what am I supposed to do as asthma patient? Saline rinse my nose for 9 months?!)

Hi, That was me, but it's my asthma that is obviously the nuggets concern as I suffer from chronic brittle asthma with many hospitalizations.

I was advised that a third of asthmatics feel better in pregnancy, a third worse and a third the same. I was lucky apart from a couple of bouts early on).

I have to have very high dose antihistamines, steroids and also take montellukast, and my care before pregnancy had to be carefully planned for to give me the best chance possible and my resp consultant is amazing.

Ultimately, beyond when I suffered from hyperemesis and was hospitalised so on a cocktail of antihistamines for this, the only things given were saline etc. And useless for me.

I think that probably unless you're in a similar category in terms of frequent hospitalisation re the asthma, then you're unlikely to get anyone to prescribe anything stronger and it will be a case of having to put up with it and make as many lifestyle changes you can to try and reduce the symptoms. So for example, if its allergic rhinitis, reducing the allergens, so wet dusting etc, if pollen/hay-fever try not to open windows etc.
At the end of the day, it is only 9 months and it will be worth every sneeze and sniffle!

I am sorry you struggle so much with allergy response and asthma. I am not planning on abandoning my current meds in pregnancy though as I don't want to take a risk and let asthma bring me to the hospital. My asthma is difficult to control and I cannot reduce allergens by staying at home for 9 months. I also have exercise induced asthma. But I shouldn't abandon exercising as it's good for they body, the baby, and lungs.
So did you keep taking all your meds throughout your pregnancy then and were fine?

@sciencepotato

I am sorry you struggle so much with allergy response and asthma. I am not planning on abandoning my current meds in pregnancy though as I don't want to take a risk and let asthma bring me to the hospital. My asthma is difficult to control and I cannot reduce allergens by staying at home for 9 months. I also have exercise induced asthma. But I shouldn't abandon exercising as it's good for they body, the baby, and lungs. So did you keep taking all your meds throughout your pregnancy then and were fine?

My steroids were maintained. Montellukast stopped. Maintaining these asthma meds was important, but you need to have a review of the meds if you haven't spoken since pregnancy or in advance of.

@sciencepotato

I am sorry you struggle so much with allergy response and asthma. I am not planning on abandoning my current meds in pregnancy though as I don't want to take a risk and let asthma bring me to the hospital. My asthma is difficult to control and I cannot reduce allergens by staying at home for 9 months. I also have exercise induced asthma. But I shouldn't abandon exercising as it's good for they body, the baby, and lungs. So did you keep taking all your meds throughout your pregnancy then and were fine?

Also, it's a balance. If the rhinitis causes asthma issues, then you need to reduce the impact as much as possible.

Have you got a consultant? I'd seek a review.

That's reassuring to hear. I am on montelukast ever since my first ivf round, my lung specialist prescribed it. I cannot imagine how bad my allergies and asthma would be without. I stopped for one single day and was in bed the next.

I do have a lung specialist yes but my ENT specialist who prescribed dymista doesn't want to advise on what alternative to take during pregnancy. And yes it's a two was road - nose affects asthma and vice versa.

Obviously this isn't of much use at the moment, but a couple of you have mentioned having a deviated septum. I had surgery to fix this about 8 years ago and the difference it has made is transformational. Had never really noticed the issue until I started suffering with hayfever in my late 20s (have exercise induced asthma in hayfever season, so nowhere near as bad as some of you do). But being able to breathe properly through my nose makes everything so much better even if it's still inflamed slightly (the surgeon also trimmed the turbinates to make sure I had more space). Not going to lie, it's not pleasant straight afterwards, but the difference means I'd do it again if I needed to.

Hey weathergirl, thanks for chiming in! That's what I was recommended by my ENT as well. Sadly I cannot afford it privately so will need to get an NHS ENT to advise the same. My question is, how long did you need to use steroid nasal spray after the surgery and do you need one now?
For years I've been given antihistamines during pollen season as well as some steroid nasal sprays but they never worked well for me and last year I developed asthma. It started as exercise induced and progressed to poorly controlled, so that I am taking all possible meds right now.

I don't use a steroid nasal spray at all. The GP tried to fob me off with one but it was pretty obvious that there was a blockage that it wasn't going to do anything ( the consultant I saw couldn't actually get the endoscope up my right nostril!). Luckily for me I had private cover through my husband's work package and as soon as I mentioned BUPA the GP was happy to refer me (though he did try to put me off saying, " if you see a consultant, you know they're a surgeon?" Which was a ridiculous thing to say as of course I knew that.).

After the op I had some nasal drops to use which were probably steroidal (I can't remember exactly) but only had to use those until everything healed. They also gave me sterimar spray but I went back to using Neilmed gently after about a week as it was more effective as flushing the gunk out with an irrigation bottle than the spray (and there was some pretty nasty stuff coming out - although might have also been connected to my sinuses as he also slightly widened the opening to those too as my sinuses are horrendous when I get colds - much better since!).

I’ve also seen a consultant (twice) about septoplasty but they explained that in my case it’s not just a deviated septum but that my anatomy is unusually small & I’d also need a FESS procedure to open my sinuses, and the latter surgery has a high failure rate by the 5 year mark.

My Dad has had FESS 3x and they’ve all failed so I’m unlikely to be a good candidate. For what it’s worth my mum has a significant septum deviation & has never had sinus issues, whereas I needed adenoid surgery as a child & very much take after my Dad with allergies and crappy sinuses!

I have found my sinusitis/post nasal drip to be very significantly worse in pregnancy - occasionally so bad it has me vomiting bile overnight or in the mornings. When not pregnant a steroid spray is usually adequate.

@FeedMeSantiago any updates from asthma uk on your issues?

@sciencepotato

Redherring, I so much hate this chronic blocked nose issue and especially combined with asthma, it sucks! Have you ever consulted an ENT regarding this? Wondering if they might have some long term solution to this, as frankly living with asthma is hard enough, and with blocked nose it's by worse by magnitude. Isnt Sedafed a decongestant spray though?

I am grateful for sharing your experience, I cannot imagine going without my asthma medication through the day. Are/were you on montelukast too?

I was referred to ENT years ago by my old GP as he believed the constant congestion and blocked nose was caused by polyps. He put me on a strong steroid spray in yhe meantime. ENT looked up my nose for all of 10 secons and declaired there was nothibg wrong with me so discharged me back to the GP. I tried explaining about the steroids but they werent having any of it. I do have polyps, I can see them bjt apparently until they are bugger (new GP said this, ENT wont do anything.

Sudafed is a decongestant. But it works by shrinking the surface capillaries within the nasal cavity. This reduces the inflammation around the polyps and lets me breathe.
Its far from idea but all the time I can get away with one spray a day Ill carry on.

Im not on montelukast and never have been.
To be honest its a struggle to get my GP to do anything except recommend saline sprays and piriton.

Yeah some really contradicting opinions out there. My ENT and lung specialist forbid all use of nasal decongestants for longer than 10 days and said they are dangerous long term and lead to rebound nasal congestion, which means the more I use it the worse it will get. So now I am on dymista, only its steroid and antihistamine component helps me breathe :( Tried avamys today and went outside and now it's all congested again, so I'll stick with dymista for as long as I can at my own risk. I dont have any nasal polyps (yet), but they could grow unless I take care of inflammation in my nose. My ENT also spent 10 seconds looking up my nose and proclaimed there are none but said only nasal endoscopy can say for sure. As for montelukast, my gp has no issues prescribing it. Funny how all depends on the doc.

@sciencepotato

Yeah some really contradicting opinions out there. My ENT and lung specialist forbid all use of nasal decongestants for longer than 10 days and said they are dangerous long term and lead to rebound nasal congestion, which means the more I use it the worse it will get. So now I am on dymista, only its steroid and antihistamine component helps me breathe :( Tried avamys today and went outside and now it's all congested again, so I'll stick with dymista for as long as I can at my own risk. I dont have any nasal polyps (yet), but they could grow unless I take care of inflammation in my nose. My ENT also spent 10 seconds looking up my nose and proclaimed there are none but said only nasal endoscopy can say for sure. As for montelukast, my gp has no issues prescribing it. Funny how all depends on the doc.

I've used Avamys and Dymista, neither of which actually helped at all. Cannot think for the life of me what they prescribed previous to that. I know about the rebound congestion but have figured if I'm always congested then I wouldn't know if it was rebound congestion or not!

Its funny though, the only time I am NEVER congested is if I am abroad....

Makes sense. After all, only you can know what helps you with your nose. Actually I am starting to think may nose just doesn't like uk climate. It all started here two years ago. Never had any issues when living on the continent... But we've got what we've got and have to work with it. I hope you can find something effective for you in the future, it truly is horrible suffering with breathing. Those who recommend only the saline solution will never get it.